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South Carolina rates for HCPCS L0626

Lumbar Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From L-1 To L-5 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.74 / $46.74 / $46.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.65 / $46.74 / $82.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $71.86 / $101.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.60 / $58.60 / $64.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $58.60 / $75.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.02 / $66.25 / $148.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.26 / $66.26 / $66.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.81 / $63.81 / $63.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.41 / $45.01 / $56.79