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South Carolina rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.59 / $88.80 / $113.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $54.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.00 / $91.00 / $114.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $147.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.40 / $75.40 / $157.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.98 / $88.80 / $113.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.00 / $190.00 / $190.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.67 / $9.67 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $13.06 / $98.30