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South Carolina rates for HCPCS L1850

Knee Orthosis Swedish Type Prefabricated Off- The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.85 / $132.85 / $132.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.85 / $132.85 / $249.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.00 / $237.02 / $330.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.43 / $214.95 / $237.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.91 / $209.30 / $214.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.85 / $233.00 / $421.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.00 / $182.00 / $196.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.12 / $219.12 / $219.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.85 / $160.34 / $203.39