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South Carolina rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,737.80 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,230.27 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,187.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,148.15 / $1,148.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $2,951.21
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $562.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,288.25