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South Carolina rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,290.87 / $3,235.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,168.69 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,570.40 / $7,244.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $5,370.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,570.40 / $2,884.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $3,235.94 / $6,760.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,090.30 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,041.74 / $3,090.30