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South Carolina rates for HCPCS L5654

Addition To Lower Extremity Socket Insert Symes (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.07 / $178.07 / $178.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.07 / $178.07 / $296.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.05 / $398.05 / $398.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.00 / $296.27 / $421.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.28 / $306.16 / $338.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $239.36 / $306.16
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.13 / $286.00 / $625.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.00 / $224.00 / $241.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.97 / $268.97 / $268.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.72 / $198.59 / $299.20