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Arizona 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
$851.40 / $940.76 / $1,664.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $221.09 / $399.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $204.00 / $277.95
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 / $1,893.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $1,422.21 / $8,437.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.09 / $796.42 / $1,199.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.09 / $796.42 / $1,199.69