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South Carolina rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $85.11 / $128.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $158.49 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $100.00 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $186.21
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $107.15 / $109.65
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $123.03 / $257.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $52.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $120.23 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $79.43 / $120.23