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South Carolina rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,187.76 / $3,388.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $4,466.84 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,754.23 / $7,079.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $5,128.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,398.83 / $2,691.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $3,235.94 / $6,918.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,951.21 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,187.76 / $3,019.95