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Colorado 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
Facility
Modifier
Low / Median / High Price
$891.25 / $1,548.82 / $1,548.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,862.09 / $3,548.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $933.25 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,202.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,621.81 / $2,511.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,621.81 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $707.95 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $707.95 / $1,071.52