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South Carolina rates for HCPCS L1852

Knee orthosis (KO), 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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $478.63 / $741.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $676.08 / $954.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $933.25 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $707.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $537.03 / $1,202.26
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $537.03 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $549.54 / $776.25