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Minnesota 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
$1,122.02 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,621.81 / $2,398.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $6,165.95 / $14,791.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,137.96 / $2,398.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $6,025.60 / $11,481.54
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,621.81 / $8,511.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $794.33 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $851.14 / $1,995.26