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New Hampshire rates for HCPCS L0636

Lumbar Sacral Orthosis 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
$999.38 / $999.38 / $1,199.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.99 / $775.50 / $999.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,774.89 / $1,774.89 / $2,103.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.78 / $970.78 / $1,018.72
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 / $1,030.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,437.05 / $1,437.05 / $4,435.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.32 / $885.47 / $1,437.05
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.34 / $1,462.27 / $1,861.08