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Maryland 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
$653.37 / $775.50 / $1,247.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.20 / $891.20 / $1,091.28
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.47 / $1,596.38 / $2,298.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.09 / $796.42 / $1,269.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.40 / $956.40 / $1,117.47