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Minnesota 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
$831.76 / $831.76 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $645.65 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,202.26 / $1,778.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,570.88 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,584.89 / $1,778.28
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,365.16 / $8,511.38
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,905.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,202.26 / $5,754.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $537.03 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $537.03 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $588.84 / $1,445.44