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South Carolina rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,480.99 / $1,480.99 / $1,480.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,480.99 / $1,480.99 / $2,464.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,915.00 / $2,414.32 / $3,509.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,474.40 / $2,482.86 / $2,741.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $1,990.83 / $2,482.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,473.19 / $2,372.00 / $5,199.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.00 / $1,861.00 / $2,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,247.08 / $2,488.46 / $2,545.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,260.42 / $1,651.61 / $2,488.46