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Mississippi 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
$1,065.19 / $1,065.19 / $1,697.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.04 / $1,135.03 / $1,697.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,472.93 / $1,472.93 / $1,472.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.93 / $1,472.93 / $1,472.93
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 / $1,497.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.94 / $884.26 / $1,292.38