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Arizona 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
$620.40 / $790.78 / $1,399.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $221.09 / $399.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $204.00 / $277.95
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 / $814.12 / $1,842.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $1,036.34 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.46 / $708.22 / $1,066.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.10 / $708.22 / $1,066.83