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South Carolina rates for HCPCS L1906

Ankle Foot Orthosis Multiligamentous Ankle Support Prefabricated Off-The-Shelf (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.63 / $76.63 / $76.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.65 / $76.63 / $135.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $110.76 / $164.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.95 / $86.88 / $93.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.42 / $85.76 / $112.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.98 / $111.00 / $243.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.00 / $87.00 / $94.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.61 / $104.61 / $104.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.49 / $73.22 / $93.07