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South Carolina rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $602.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $741.31 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $524.81 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $954.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $446.68 / $501.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $562.34 / $1,148.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $562.34 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $371.54 / $562.34