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Maine 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
$556.19 / $668.85 / $668.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$980.05 / $1,269.74 / $2,353.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.78 / $688.15 / $688.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $711.81 / $711.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $519.62 / $711.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.18 / $892.18 / $892.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.45 / $668.85 / $668.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.49 / $580.30 / $1,264.23