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South Carolina rates for HCPCS L0625

Lumbar Orthosis Flexible Provides Lumbar Support Posterior Extends From L-1 To Below L-5 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Pendulous Abdomen Design Shoulder Straps Stays Prefabricated Offthe Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.57 / $24.43 / $54.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.67 / $24.04 / $44.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.69 / $26.29 / $142.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.43 / $65.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $42.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $38.15 / $51.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.04 / $41.67 / $80.67
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.83 / $46.83 / $46.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.11 / $45.11 / $45.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.78 / $64.78 / $64.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.05 / $31.69 / $44.57