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Colorado 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
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,819.70 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,659.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,137.96 / $4,073.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $977.24 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,096.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,905.46 / $6,456.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,905.46 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $794.33 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $794.33 / $1,202.26