go back

Alaska rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.64 / $1,328.64 / $1,328.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,115.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $1,115.23 / $1,188.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $457.21 / $457.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,473.45 / $1,473.45 / $2,326.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $457.21 / $1,115.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $1,188.90 / $1,817.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.63 / $1,483.07 / $1,934.45