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South Carolina rates for HCPCS L0628

Lumbar-Sacral Orthosis Flexible Provides Lumbo-Sacral Support Posterior Extends From Sacro- Coccygeal Juntion To T-9 Vertebra Produces Intra-Cavitary Pressure To Reduce Load On The Inter- Vertebral Discs Includes Straps Closures May Include Stays Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.60 / $36.60 / $36.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.60 / $36.60 / $68.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.52 / $82.52 / $82.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $56.73 / $94.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $63.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $90.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.60 / $63.45 / $122.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.28 / $71.28 / $71.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.65 / $68.65 / $68.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.79 / $48.23 / $63.73