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South Carolina rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.34 / $44.25 / $44.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.34 / $32.68 / $57.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.69 / $45.43 / $95.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.43 / $71.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.39 / $46.70 / $51.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $39.68 / $69.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.37 / $48.00 / $103.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.00 / $37.00 / $40.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.59 / $44.59 / $44.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.18 / $87.18 / $87.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.11 / $32.61 / $43.97