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South Carolina rates for HCPCS L0642

Lumbar Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From L-L To Below L-5 Vertebra Produces Intra- Cavitary Pressure To Reduce Load On The Inter- Vertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.35 / $179.35 / $179.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.28 / $179.35 / $335.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.00 / $415.00 / $415.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.00 / $370.66 / $487.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $332.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $301.51 / $314.97
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.73 / $304.89 / $669.24
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.74 / $389.74 / $389.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.49 / $336.49 / $336.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.62 / $237.35 / $344.05