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South Carolina rates for HCPCS L1843

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $954.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $812.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,096.48 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $707.95 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $1,258.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $630.96 / $707.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $812.83 / $1,698.24
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $562.34 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $537.03 / $676.08