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South Carolina rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.57 / $184.57 / $184.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.87 / $184.57 / $307.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.00 / $295.37 / $437.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.76 / $239.78 / $264.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.04 / $239.78 / $248.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.59 / $296.00 / $647.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.00 / $232.00 / $249.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.11 / $203.99 / $278.63