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South Carolina rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$916.26 / $916.26 / $916.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.26 / $916.26 / $1,524.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.65 / $2,607.40 / $3,485.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $2,125.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $1,231.67 / $1,317.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$911.42 / $1,468.00 / $3,216.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.00 / $1,152.00 / $1,238.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.58 / $1,012.69 / $1,367.91