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South Carolina rates for HCPCS L0636

Lumbar Sacral Orthosis 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