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South Carolina rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,352.55 / $1,352.55 / $1,352.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.05 / $1,352.55 / $2,250.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,750.00 / $2,206.29 / $3,204.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.50 / $1,902.78 / $2,100.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,818.14 / $1,902.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,345.42 / $2,166.00 / $4,748.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.00 / $1,700.00 / $1,827.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,043.03 / $2,043.03 / $2,043.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.57 / $1,494.91 / $2,210.98