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South Carolina rates for HCPCS L5857

Addition To Lower Proximity Prosthesis Endoskeletal Knee-Shin System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,625.16 / $4,625.16 / $4,625.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,423.59 / $4,625.16 / $7,695.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,338.95 / $10,338.95 / $12,441.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $7,344.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $6,217.38 / $6,652.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,600.78 / $7,253.61 / $16,237.27
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,253.61 / $7,253.61 / $7,253.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,473.05 / $5,111.97 / $6,933.27