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New Hampshire 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
$616.60 / $616.60 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $616.60 / $1,096.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,202.26 / $1,380.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
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 / $524.81 / $707.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $537.03 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $549.54 / $954.99
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,380.38