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South Carolina rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $251.19 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $436.52 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $275.42 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $562.34
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $309.03 / $338.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $338.84 / $758.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $295.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $323.59 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $218.78 / $323.59