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South Carolina rates for HCPCS L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral 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
$544.26 / $544.26 / $874.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.91 / $549.77 / $1,015.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$827.97 / $827.97 / $847.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $378.22 / $1,337.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $897.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $952.31
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $898.49 / $2,194.26
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.74 / $1,290.74 / $1,290.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.37 / $1,114.37 / $1,114.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.39 / $774.44 / $994.18