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South Carolina rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $154.88 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $213.80 / $281.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $263.03 / $354.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $346.74 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $234.42 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $478.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $245.47 / $275.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $281.84 / $616.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $257.04 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $173.78 / $263.03