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South Carolina rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,905.46 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,311.31 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $2,454.71 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $4,466.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,137.96 / $2,187.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $2,630.27 / $5,370.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
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 / $2,454.71 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $2,511.89