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New Mexico 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
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $60.26 / $70.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $85.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $380.19