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West 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
$557.11 / $557.11 / $557.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.34 / $533.17 / $557.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$837.29 / $1,455.80 / $1,887.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.94 / $901.70 / $1,545.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $711.81 / $1,509.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $711.81 / $5,887.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.91 / $576.42 / $896.64