go back

Georgia 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
$912.01 / $912.01 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $912.01 / $1,698.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,584.89 / $2,398.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,949.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,949.84 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $776.25 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $1,659.59