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South Carolina rates for HCPCS L4631

Ankle Foot Orthosis Walking Boot Type Varus/ Valgus Correction Rocker Bottom Anterior Tibial Shell Soft Interface Custom Arch Support Plastic Or Other Material Includes Straps And Closures Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.75 / $894.75 / $894.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$885.32 / $894.75 / $1,582.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.67 / $1,807.78 / $1,807.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.00 / $1,263.26 / $1,916.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,145.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,037.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.75 / $1,357.20 / $2,925.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,357.20 / $1,357.20 / $1,357.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.25 / $861.67 / $1,221.48