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South Carolina rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,862.09 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $2,570.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,122.02 / $1,258.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,412.54 / $3,019.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,412.54 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,412.54