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South Carolina rates for HCPCS L0634

Lumbar-Sacral Orthosis Sagittal-Coronal Control With Rigid Posterior Frame/Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Lateral Strength Provided By Rigid Lateral Frame/Panel(S) Produces Intracavitary Pressure To Reduce Load On Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $206.00 / $259.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $350.00 / $472.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00