go back

South Carolina rates for HCPCS L5685

Addition To Lower Extremity Prosthesis Below Kneesuspension/Sealing Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.55 / $69.55 / $69.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.68 / $69.55 / $115.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.82 / $108.82 / $139.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.30 / $127.99 / $182.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $110.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $97.88 / $100.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.05 / $109.06 / $244.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.06 / $109.06 / $109.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.05 / $105.05 / $105.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.96 / $76.87 / $103.83