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South Carolina rates for HCPCS L5858

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,091.35 / $10,091.35 / $10,091.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,529.76 / $10,091.35 / $16,789.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,557.89 / $22,557.89 / $27,146.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $16,024.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $13,565.29 / $14,513.81
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,038.16 / $15,826.18 / $35,427.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,826.18 / $15,826.18 / $15,826.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,577.62 / $11,153.51 / $15,065.75