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South Carolina rates for HCPCS L2387

Addition To Lower Extremity Polycentric Knee Joint For Custom Fabricated Knee Ankle Foot Orthosis Each Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.35 / $101.35 / $101.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.25 / $101.35 / $179.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $147.68 / $217.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $116.51 / $128.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.05 / $116.50 / $123.16
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.53 / $149.86 / $331.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.86 / $149.86 / $149.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.37 / $138.37 / $138.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.05 / $105.48 / $140.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.11 / $97.61 / $125.39