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Connecticut 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
$753.84 / $753.84 / $753.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.97 / $741.41 / $758.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.03 / $1,551.00 / $1,774.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.90 / $929.30 / $929.30
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 / $1,115.23
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.15 / $1,008.15 / $1,008.15
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.15 / $1,008.15 / $1,426.92
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.32 / $1,132.32 / $1,132.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.51 / $773.78 / $1,289.63