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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
$332.67 / $332.67 / $332.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.67 / $332.67 / $553.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.00 / $548.41 / $788.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.20 / $530.41 / $585.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $519.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.91 / $533.00 / $1,052.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.00 / $418.00 / $449.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.49 / $502.49 / $502.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.80 / $370.99 / $558.96