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South Carolina rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.74 / $953.74 / $953.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.48 / $953.74 / $1,586.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,557.01 / $2,259.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$949.51 / $1,620.00 / $1,788.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,282.06 / $1,620.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$948.71 / $1,528.00 / $3,348.23
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,199.00 / $1,199.00 / $1,288.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,440.63 / $1,440.63 / $1,440.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.46 / $2,783.46 / $2,783.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.69 / $1,054.11 / $1,569.19