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Virginia 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
$441.35 / $533.17 / $533.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.35 / $533.17 / $647.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.36 / $1,078.36 / $1,145.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.78 / $656.78 / $833.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.01 / $602.01 / $737.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $711.81 / $711.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $519.62 / $711.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.86 / $970.53 / $1,294.04
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.31 / $663.22 / $1,209.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.21 / $1,347.96 / $1,796.20
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.80 / $813.84 / $1,291.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.80 / $813.84 / $1,291.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.24 / $537.98 / $810.40