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North Dakota 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $4,786.30