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South Carolina rates for HCPCS L0635

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $1,122.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,288.25 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $1,380.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $724.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $851.14 / $2,089.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $346.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $630.96 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $630.96 / $812.83