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South Carolina rates for HCPCS L5822

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$914.34 / $914.34 / $914.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$914.34 / $914.34 / $1,521.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.00 / $1,500.28 / $2,166.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.30 / $1,367.82 / $1,510.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.51 / $1,229.09 / $1,367.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$909.52 / $1,465.00 / $3,209.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.00 / $1,149.00 / $1,235.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.12 / $1,381.12 / $1,381.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1,536.34 / $1,614.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.58 / $1,019.68 / $1,536.34