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South Carolina rates for HCPCS L5830

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.85 / $1,018.85 / $1,018.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.85 / $1,018.85 / $1,695.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,320.00 / $1,624.52 / $2,414.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,014.30 / $1,654.54 / $1,826.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,207.81 / $1,369.58 / $1,654.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.48 / $1,632.00 / $3,576.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,281.00 / $1,281.00 / $1,376.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.98 / $1,538.98 / $1,538.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.48 / $1,136.22 / $1,711.94