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South Carolina rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.65 / $168.65 / $168.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.82 / $168.65 / $298.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.00 / $249.62 / $361.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.74 / $189.91 / $209.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $189.91 / $204.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.27 / $245.00 / $535.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.00 / $192.00 / $206.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.24 / $230.24 / $230.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.83 / $164.26 / $204.90