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South Carolina rates for HCPCS L2795

Addition To Lower Extremity Orthosis Knee Control Full Kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.38 / $47.38 / $47.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.07 / $47.38 / $83.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.22 / $62.22 / $75.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.00 / $70.59 / $101.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.63 / $62.81 / $69.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $56.69 / $62.81
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.60 / $69.00 / $150.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $58.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.68 / $64.68 / $64.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $47.33 / $63.68