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Hawaii 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
$578.79 / $578.79 / $578.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,120.40 / $2,120.40 / $2,120.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.36 / $2,936.05 / $2,936.05
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,669.14 / $2,794.91 / $2,794.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,601.48 / $2,669.14 / $3,736.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.36 / $2,120.40 / $2,936.05
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,150.09 / $2,223.78 / $2,540.53