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Wisconsin rates for HCPCS L0635

Lumbar-Sacral Orthosis 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
$607.34 / $607.34 / $607.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.34 / $611.73 / $1,161.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,203.94 / $1,324.33 / $2,191.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.66 / $1,119.66 / $1,480.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.11 / $2,576.42 / $2,576.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $2,657.88 / $5,025.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $1,772.60 / $2,278.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.31 / $911.01 / $1,384.53
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.35 / $1,203.94 / $1,444.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.22 / $1,203.94 / $5,716.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.17 / $630.66 / $1,344.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $812.49
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.31 / $911.01 / $1,384.53
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.35 / $1,203.94 / $1,444.73
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.94 / $1,852.82 / $3,227.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $2,351.44 / $5,716.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $711.81 / $8,653.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.94 / $1,203.94 / $1,203.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.32 / $1,203.94 / $1,203.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.24 / $601.58 / $1,151.21