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South Carolina rates for HCPCS L5301

Below Knee, Molded Socket, Shin, Sach Foot, Endoskeletal System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,476.95 / $1,476.95 / $1,476.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.33 / $1,476.95 / $2,457.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.49 / $2,311.06 / $3,301.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.40 / $2,685.39 / $3,836.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.92 / $1,721.98 / $1,901.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,721.98 / $1,985.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,453.41 / $2,365.00 / $5,185.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,847.00 / $1,847.00 / $1,847.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,230.94 / $2,230.94 / $2,230.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,674.38 / $3,674.38 / $3,674.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,109.04 / $1,632.40 / $2,071.46