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Idaho 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
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,174.90 / $1,819.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $707.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $1,096.48 / $1,479.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,202.26 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,071.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,202.26 / $1,202.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,380.38
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $616.60 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $537.03 / $794.33