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South Carolina rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.01 / $34.01 / $34.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.24 / $34.01 / $63.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.19 / $46.02 / $85.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $71.86 / $92.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $57.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $59.73
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $57.82 / $126.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.91 / $73.91 / $73.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.81 / $63.81 / $63.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.41 / $44.35 / $63.08