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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
$45.00 / $45.00 / $45.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.35 / $277.35 / $277.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $45.00 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,790.84 / $4,790.84 / $4,790.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,790.84 / $4,790.84 / $4,790.84