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Idaho 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
$838.71 / $1,418.72 / $1,418.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,335.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,970.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $1,217.61 / $1,876.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.20 / $1,539.21 / $1,620.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,195.72 / $1,424.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,418.72 / $1,582.25 / $2,373.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,134.15 / $1,182.76 / $1,701.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.35 / $796.42 / $1,255.55