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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
$758.74 / $1,762.65 / $20,868.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.81 / $852.61 / $1,188.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,597.72 / $2,236.81 / $5,863.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.27 / $1,328.47 / $2,550.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.35 / $1,358.06 / $2,955.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.06 / $1,358.06 / $1,358.06
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.27 / $1,597.72 / $2,821.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.32 / $1,975.30 / $2,955.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.39 / $797.08 / $1,315.04