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South Carolina rates for HCPCS L1907

Ankle orthosis (AO), supramalleolar with straps, with or without interface/pads, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $354.81 / $602.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $660.69 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $416.87 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $794.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $398.11 / $446.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $501.19 / $1,071.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $194.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $380.19 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $338.84 / $426.58