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South Carolina rates for HCPCS L0627

Lumbar Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From L-1 To Below L-5 Vertebra Produces Intra- Cavitary Pressure To Reduce The Load On The Inter-Vertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated 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
$246.47 / $246.47 / $246.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.46 / $246.47 / $436.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.24 / $497.97 / $497.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.00 / $370.66 / $528.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.81 / $312.81 / $345.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.35 / $312.81 / $342.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.59 / $349.36 / $782.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.36 / $349.36 / $349.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.49 / $336.49 / $336.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.62 / $237.35 / $299.45