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South Carolina rates for HCPCS L5930

Addition Endoskeletal System High Activity Knee Control Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,827.60 / $1,827.60 / $1,827.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,760.55 / $1,827.60 / $3,040.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,606.63 / $3,359.81 / $4,800.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$873.51 / $2,282.71 / $2,520.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.39 / $1,666.39 / $2,572.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,817.97 / $2,927.00 / $6,416.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,297.00 / $2,297.00 / $2,469.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,760.62 / $2,760.62 / $2,760.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,982.23 / $1,982.23 / $1,982.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.76 / $1,947.28 / $2,746.00