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South Carolina rates for HCPCS L5920

Addition Endoskeletal System Above Knee Or Hip Disarticulation Alignable System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.89 / $284.89 / $284.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.14 / $284.89 / $473.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.45 / $310.45 / $310.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.00 / $466.48 / $675.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.63 / $397.94 / $439.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $382.96 / $397.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.39 / $457.00 / $1,000.16
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.00 / $358.00 / $385.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.33 / $430.33 / $430.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.93 / $317.70 / $478.70