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South Carolina rates for HCPCS L4397

Static Or Dynamic Ankle Foot Orthosis Including Soft Interface Material Adjustable For Fit For Positioning May Be Used For Minimal Ambulation Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.64 / $100.64 / $100.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.56 / $112.90 / $178.05
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.16 / $156.77 / $205.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $131.13 / $213.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $127.07 / $140.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $128.69
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.64 / $159.13 / $329.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.13 / $159.13 / $159.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.39 / $137.39 / $137.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.63 / $97.45 / $141.12