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South Carolina rates for HCPCS L3720

Elbow Orthosis Double Upright With Forearm/Arm Cuffs Free Motion Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.70 / $394.70 / $394.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.57 / $394.70 / $698.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.00 / $586.24 / $845.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.17 / $450.57 / $497.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.92 / $450.57 / $479.56
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.87 / $572.00 / $1,252.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.00 / $448.00 / $482.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.87 / $538.87 / $538.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.23 / $380.11 / $484.95