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Wyoming 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
Professional
Modifier
Low / Median / High Price
$1,050.86 / $1,050.86 / $1,643.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,832.58 / $1,832.58 / $1,832.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,832.58 / $1,832.58 / $1,832.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $2,181.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,584.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.81 / $796.42 / $884.18