go back

New Jersey 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
$390.26 / $390.26 / $390.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.26 / $498.88 / $647.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $711.81 / $1,146.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $519.62 / $1,003.82
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.31 / $1,054.68 / $1,501.77
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.52 / $1,146.39 / $1,146.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.49 / $571.91 / $1,146.39