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Kansas 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
$1,642.47 / $1,642.47 / $1,642.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.15 / $1,076.09 / $1,642.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,465.72 / $1,599.17 / $1,696.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,587.31 / $1,587.31 / $1,587.31
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 / $2,367.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $1,598.51 / $8,437.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.94 / $956.55 / $2,533.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.32 / $947.33 / $1,266.99