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Minnesota rates for HCPCS L0634

Lumbar-sacral orthosis (LSO), 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.82 / $58.82 / $346.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.06 / $58.82 / $58.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $350.00 / $591.50
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