go back

South Carolina rates for HCPCS L1990

Ankle Foot Orthosis Double Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Double Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.93 / $262.93 / $262.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.62 / $262.93 / $465.17
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.87 / $371.87 / $371.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.00 / $379.06 / $563.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.60 / $313.79 / $346.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $313.79 / $319.45
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.40 / $381.00 / $834.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.00 / $299.00 / $321.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.97 / $358.97 / $358.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.69 / $252.20 / $337.74