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South Carolina rates for HCPCS L5972

All Lower Extremity Prostheses Foot Flexible Keel (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.69 / $203.69 / $203.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.68 / $203.69 / $338.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.73 / $413.17 / $455.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.00 / $334.10 / $482.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.79 / $293.77 / $324.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $273.81 / $293.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.61 / $327.00 / $715.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.00 / $256.00 / $275.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.67 / $307.67 / $307.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.00 / $564.00 / $564.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.36 / $225.13 / $317.95