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Georgia 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
$758.58 / $1,778.28 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $812.83 / $1,412.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,890.45 / $6,025.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,318.26 / $1,995.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,862.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,621.81 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $691.83 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $776.25 / $1,380.38