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South Carolina rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.14 / $318.14 / $318.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.25 / $318.14 / $529.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.82 / $497.82 / $640.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $479.08 / $753.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.06 / $440.05 / $485.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $427.67 / $440.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.47 / $510.00 / $1,116.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.00 / $398.00 / $398.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.56 / $480.56 / $480.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.89 / $351.63 / $502.37