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Tennessee 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
$855.14 / $855.14 / $934.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.00 / $855.14 / $1,600.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.48 / $1,710.68 / $1,710.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$853.32 / $1,030.36 / $1,030.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,030.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,969.92 / $8,437.43 / $10,110.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,969.29 / $11,232.54 / $12,751.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.17 / $902.36 / $1,253.07