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South Carolina rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.10 / $43.10 / $43.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.93 / $43.10 / $71.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.00 / $70.59 / $102.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.91 / $60.21 / $66.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $57.94 / $60.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.88 / $70.00 / $151.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $58.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.10 / $65.10 / $65.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $48.07 / $72.43