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South Carolina rates for HCPCS L1907

Afo Orthosis Supramalleolar With Straps With Orwithout Interface/Pads Custom Fabricated (Revised01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.37 / $337.37 / $337.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.67 / $337.37 / $596.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.00 / $458.91 / $722.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.75 / $419.48 / $463.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $409.91 / $419.48
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.32 / $479.00 / $1,070.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.00 / $410.00 / $410.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.60 / $460.60 / $460.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.71 / $324.89 / $409.91