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South Carolina rates for HCPCS L3925

Finger orthosis (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.41 / $80.34 / $80.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.13 / $32.67 / $74.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $39.09 / $61.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $40.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $36.61 / $36.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.53 / $43.77 / $94.23
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.77 / $43.77 / $43.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.35 / $39.35 / $39.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.37 / $27.76 / $37.52