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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
$195.22 / $195.22 / $195.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.22 / $195.22 / $324.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.00 / $321.48 / $462.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.37 / $366.26 / $404.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.19 / $313.00 / $685.36
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.00 / $245.00 / $264.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.88 / $294.88 / $294.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $217.72 / $328.04