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South Carolina rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.00 / $256.00 / $256.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.03 / $256.00 / $425.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.00 / $422.34 / $606.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.08 / $493.58 / $544.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $493.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.65 / $410.00 / $898.72
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.00 / $322.00 / $346.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.01 / $763.01 / $763.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.87 / $285.49 / $430.15