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South Carolina rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,172.55 / $2,172.55 / $2,172.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,051.64 / $2,172.55 / $3,614.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,600.00 / $3,277.91 / $5,147.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,038.30 / $2,886.72 / $3,187.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $2,920.45
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,161.10 / $3,479.00 / $7,627.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,717.00 / $2,717.00 / $2,717.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,281.66 / $3,281.66 / $3,281.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,753.36 / $5,753.36 / $5,753.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.37 / $2,401.21 / $3,243.48