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California rates for HCPCS L0632

Lumbar-sacral orthosis (LSO), sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the 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
$44.67 / $44.67 / $44.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $2,570.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,905.46 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $380.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $630.96 / $831.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $100.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95