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South Carolina rates for HCPCS L4350

Ankle Control Orthosis Stirrup Style Rigid Includes Any Type Interface (E.G. Pneumatic Gel)Prefabricated Off-The-Shelf (Revised 01/01/14) D 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.07 / $31.05 / $67.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.31 / $58.63 / $103.73
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.00 / $77.00 / $120.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.25 / $24.49 / $111.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.00 / $84.92 / $125.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.76 / $68.22 / $75.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.80 / $68.22 / $73.06
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.71 / $85.00 / $186.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.00 / $67.00 / $72.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $80.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $55.63 / $71.23