go back

New Mexico 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
$796.68 / $796.68 / $796.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.68 / $1,223.47 / $6,141.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$973.40 / $1,297.85 / $1,546.41
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 / $2,007.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.76 / $1,624.70 / $2,437.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $514.15 / $1,220.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $1,030.36 / $1,903.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.14 / $796.42 / $1,199.69