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California rates for HCPCS L0635

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $6,309.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $645.65 / $5,495.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $630.96 / $2,818.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,659.59
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,511.89 / $3,388.44
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,691.53 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $707.95
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,778.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,318.26 / $2,290.87
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,912.51 / $8,912.51 / $8,912.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $1,258.93 / $1,778.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $1,202.26
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,148.15 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $537.03 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $1,445.44