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New Jersey 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
$578.79 / $578.79 / $578.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.79 / $739.88 / $958.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,700.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,893.75
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.24 / $1,564.17 / $2,227.23
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,488.74 / $1,660.33 / $1,700.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.81 / $848.20 / $1,700.18