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South Carolina rates for HCPCS L0458

Tlso Triplanar Control Modular Segmented Spinal System Two Rigid Plastic Shells Posterior Extends From The Sacrococcygeal Junction And Terminates Just Inferior To The Scapular Spine Anterior Extends From The Symphysis Pubis To The Xiphoid Soft Liner Restricts Gross Trunk Motion In The Sagittal Coronal And Tranverse Planes Lateral Strengthis Provided By Overlapping Plastic And Stabilizing Closures Includes Straps And Closures Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.72 / $534.72 / $534.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.05 / $534.72 / $946.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.00 / $693.40 / $1,145.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.61 / $695.41 / $767.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.65 / $680.18 / $859.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.76 / $774.00 / $1,696.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.00 / $604.00 / $604.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.03 / $730.03 / $730.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.32 / $512.89 / $649.67