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South Carolina rates for HCPCS L1845

Knee Orthosis Double 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$561.59 / $561.59 / $561.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.33 / $561.59 / $993.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.00 / $832.09 / $1,203.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.35 / $632.51 / $698.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $632.51 / $682.34
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.91 / $797.00 / $1,644.55
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.00 / $638.00 / $686.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.71 / $766.71 / $766.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.38 / $535.96 / $692.00