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South Carolina rates for HCPCS L1851

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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.21 / $405.21 / $405.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.21 / $438.73 / $758.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.95 / $900.95 / $900.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.00 / $762.74 / $1,076.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $703.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $636.97 / $712.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.21 / $567.72 / $1,460.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.03 / $866.03 / $866.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.47 / $734.47 / $734.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $521.96 / $731.02