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South Carolina rates for HCPCS L0112

Cranial Cervical Orthosis Congenital Torticollis Type With Or Without Soft Interface Material Adjustable Range Of Motion Joint Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$839.17 / $839.17 / $839.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.79 / $839.17 / $1,484.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,695.48 / $1,695.48 / $2,040.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.90 / $941.33 / $1,039.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $941.33 / $1,019.59
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.48 / $1,190.00 / $2,662.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.69 / $1,145.69 / $1,145.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.90 / $814.18 / $1,019.59