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Indiana rates for HCPCS L0634

Lumbar-Sacral Orthosis Sagittal-Coronal Control With Rigid 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 Stays Shoulder Straps Pendulous Abdomen Design Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.30 / $301.30 / $581.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.31 / $301.30 / $397.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.64 / $332.34 / $332.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.72 / $397.72 / $397.72