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South Carolina rates for HCPCS L5968

Addition To Lower Limb Prosthesis Multiaxial Ankle With Swing Phase Active Dorsiflexion Feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,973.14 / $1,973.14 / $1,973.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.33 / $1,973.14 / $3,282.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,978.24 / $2,978.24 / $4,281.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,734.00 / $3,464.42 / $4,949.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.07 / $2,448.80 / $2,703.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $2,448.80 / $2,652.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,962.74 / $3,160.00 / $6,926.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,467.00 / $2,467.00 / $2,665.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.64 / $2,180.83 / $2,945.77