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South Carolina rates for HCPCS L5828

Addition Endoskeletal Knee-Shin System Single Axis Fluid Swing And Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,516.26 / $1,516.26 / $1,516.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,516.26 / $1,516.26 / $2,522.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,965.00 / $2,477.35 / $3,592.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,509.50 / $2,117.90 / $2,338.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $1,546.07 / $2,251.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,508.27 / $2,428.00 / $5,323.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,906.00 / $1,906.00 / $2,048.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.33 / $2,290.33 / $2,290.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.29 / $1,690.94 / $2,547.73