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Connecticut 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
$862.66 / $862.66 / $862.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.88 / $787.52 / $862.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.54 / $1,774.89 / $2,030.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.78 / $970.78 / $1,018.72
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
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.68 / $1,153.68 / $1,153.68
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.11 / $1,153.68 / $1,564.17
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.95 / $1,163.95 / $1,163.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.75 / $885.47 / $1,709.27