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South Carolina rates for HCPCS L5814

Addition Endoskeletal Knee-Shin System Polycentric Hydraulic Swing Phase Control Mechanical Stance Phase Lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,016.55 / $2,016.55 / $2,016.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,904.31 / $2,016.55 / $3,355.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.52 / $2,197.52 / $2,197.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,761.00 / $3,480.89 / $4,889.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,007.60 / $2,502.67 / $2,763.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.95 / $2,502.67 / $2,710.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.92 / $3,229.00 / $7,079.39
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,535.00 / $2,535.00 / $2,724.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,046.02 / $3,046.02 / $3,046.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,564.52 / $2,228.80 / $3,010.58