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South Carolina rates for HCPCS L1812

Knee orthosis (KO), elastic with joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.75 / $49.75 / $49.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $52.67 / $148.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.02 / $103.55 / $125.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $107.16 / $143.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.97 / $84.97 / $93.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.03 / $84.97 / $87.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.72 / $83.45 / $205.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.79 / $114.79 / $114.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.10 / $99.10 / $99.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.42 / $65.84 / $91.83