go back

Alaska rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,138.27 / $2,138.27 / $2,138.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,030.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $752.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $514.15 / $514.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.21 / $2,371.31 / $3,744.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $514.15 / $1,030.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $1,201.65 / $2,025.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.43 / $2,386.80 / $3,113.22