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South Carolina rates for HCPCS L5637

Addition To Lower Extremity Below Knee Total Contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.11 / $155.11 / $155.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.11 / $155.11 / $258.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.04 / $242.72 / $346.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.00 / $258.45 / $367.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.43 / $232.98 / $257.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $208.51 / $232.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.29 / $249.00 / $544.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.00 / $195.00 / $210.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.29 / $234.29 / $234.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.44 / $172.98 / $260.63