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South Carolina rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,412.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $1,548.82 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,862.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,047.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,148.15 / $2,511.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $457.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $891.25 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $794.33 / $1,000.00