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South Carolina rates for HCPCS L5706

Custom shaped protective cover, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $630.96 / $851.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,122.02 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $954.99 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,548.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $851.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $870.96 / $1,905.46
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $812.83 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $562.34 / $812.83