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South Carolina rates for HCPCS L1843

Knee Orthosis Single Upright Thigh And Calf With Adjustable Flexion And Extension Joint (Uni- Centric Or Polycentric) Medial-Lateral And Rotation Control With Or Without Varus/Valgus Adjustment Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise 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
$537.97 / $537.97 / $537.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.19 / $537.97 / $951.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.92 / $1,086.92 / $1,086.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.00 / $793.34 / $1,178.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.40 / $702.03 / $775.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $653.63 / $702.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.68 / $779.00 / $1,707.01
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.00 / $612.00 / $657.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $518.08 / $653.63