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South Carolina rates for HCPCS L5656

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.43 / $202.43 / $202.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.43 / $202.43 / $336.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.00 / $334.10 / $479.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.54 / $335.84 / $370.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $328.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.37 / $325.00 / $710.67
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.00 / $254.00 / $273.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.77 / $305.77 / $305.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.01 / $223.74 / $334.67