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Rhode Island 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
$501.19 / $676.08 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,187.76 / $2,570.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $616.60 / $1,174.90
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $660.69 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $912.01