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South Carolina rates for HCPCS L3915

Wrist Hand Orthosis Includes One Or More Non- Torsion Joint(S) Elastic Bands Turnblocks May Include Soft Interface Straps Prefabricated Itemthat Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.07 / $290.07 / $290.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.31 / $290.07 / $513.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.05 / $586.05 / $705.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $325.37 / $359.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.52 / $426.75 / $467.69
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.71 / $440.42 / $920.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.42 / $440.42 / $440.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.92 / $277.95 / $362.88