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South Carolina rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,691.53 / $3,981.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $5,128.61 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,548.13 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $6,456.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,019.95 / $3,388.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,801.89 / $8,128.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $3,467.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,630.78 / $6,606.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,570.40 / $3,630.78