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South Carolina rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.76 / $940.76 / $940.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.14 / $940.76 / $1,664.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.04 / $1,441.02 / $2,016.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,137.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,143.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.31 / $1,317.06 / $2,985.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,333.52 / $1,333.52 / $1,333.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,284.39 / $1,284.39 / $1,284.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.17 / $883.76 / $1,143.02