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South Carolina rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $346.74 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $616.60 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $501.19 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $831.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $389.05 / $436.52
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $467.74 / $977.24
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $190.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $436.52 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $302.00 / $436.52