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South Carolina rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $199.53 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $346.74 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $213.80 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $446.68
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $234.42 / $257.04
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $288.40 / $588.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $112.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $213.80 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $173.78 / $229.09