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South Carolina rates for HCPCS L3762

Elbow Orthosis Rigid Without Joints Includes Soft Interface Material Prefabricated Off-The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.68 / $58.68 / $58.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.08 / $58.68 / $103.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $77.06 / $91.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.52 / $94.76 / $135.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.29 / $65.81 / $72.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $71.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.76 / $85.00 / $186.20
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $66.00 / $66.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.11 / $80.11 / $80.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.44 / $140.44 / $140.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $56.51 / $79.16