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South Carolina rates for HCPCS L4205

Repair Of Orthotic Device Labor Component Per 15 Minutes (Special Coverage Instructions Apply. See Mcm: 2100.4)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.96 / $422.91 / $422.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.96 / $23.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.50 / $15.38 / $30.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.75 / $22.22 / $22.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $22.22 / $23.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.00 / $20.94 / $48.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $17.00 / $17.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.71 / $9.71 / $9.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.51 / $14.04 / $18.48