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South Carolina rates for HCPCS L5722

Addition Exoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516.75 / $516.75 / $516.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.19 / $516.75 / $859.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.00 / $844.70 / $1,224.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.46 / $875.29 / $966.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $694.64 / $875.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.02 / $828.00 / $1,814.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.00 / $650.00 / $698.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.54 / $780.54 / $780.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.03 / $571.13 / $814.56