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South Carolina rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.20 / $32.20 / $45.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.63 / $50.36 / $81.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.15 / $83.29 / $95.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $66.45 / $98.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.21 / $58.00 / $64.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $56.93 / $58.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.18 / $67.00 / $145.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $52.00 / $56.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.53 / $62.53 / $62.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.78 / $44.87 / $60.49