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Indiana 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
$595.88 / $595.88 / $1,203.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.97 / $599.66 / $653.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$951.11 / $1,077.53 / $1,203.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.33 / $656.78 / $886.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$966.11 / $1,324.33 / $1,805.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.35 / $1,324.33 / $1,625.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $711.81 / $1,203.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $711.81 / $1,235.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.66 / $582.82 / $810.58