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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
$790.78 / $790.78 / $790.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.81 / $790.78 / $1,399.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.10 / $1,202.75 / $1,695.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,231.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $960.80 / $1,115.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.97 / $1,120.93 / $2,509.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.93 / $1,120.93 / $1,120.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.62 / $1,079.62 / $1,079.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.39 / $757.73 / $960.55