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South Carolina rates for HCPCS L5677

Additions To Lower Extremity Below Knee Knee Joints Polycentric Pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.74 / $264.74 / $264.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.52 / $264.74 / $440.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.00 / $434.96 / $627.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.57 / $400.78 / $442.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $355.88 / $400.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.33 / $424.00 / $929.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.00 / $333.00 / $358.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.79 / $295.24 / $444.83