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South Carolina rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $251.19 / $354.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $436.52 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $363.08 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $602.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $275.42 / $309.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $346.74 / $707.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $295.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $323.59 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $218.78 / $331.13