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South Carolina rates for HCPCS L1930

Ankle Foot Orthosis Plastic Or Other Material Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.98 / $131.90 / $233.36
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.51 / $266.51 / $266.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.77 / $101.58 / $118.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $199.81 / $282.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.70 / $175.81 / $194.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.34 / $175.81 / $191.33
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.59 / $191.00 / $418.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $161.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.08 / $180.08 / $180.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.64 / $131.77 / $168.70