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South Carolina rates for HCPCS L1620

Hip Orthosis Abduction Control Of Hip Joints Flexible (Pavlik Harness) Prefabricated Item That Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.61 / $222.70 / $222.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.69 / $80.61 / $142.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $119.78 / $172.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.54 / $117.36 / $129.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $126.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.47 / $117.00 / $255.78
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.00 / $92.00 / $98.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.05 / $110.05 / $110.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.17 / $77.31 / $101.52