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Michigan 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
$691.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $912.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,630.78 / $6,918.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,202.26 / $1,258.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
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 / $707.95 / $1,412.54
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $2,290.87 / $2,570.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $954.99 / $1,479.11
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $707.95 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $954.99 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $562.34 / $870.96