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Idaho 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
$611.15 / $1,358.11 / $1,358.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$972.82 / $1,115.23 / $1,115.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $814.12 / $1,188.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $1,092.54 / $1,551.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,395.90 / $1,473.45 / $1,551.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,144.63 / $1,363.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,358.11 / $1,514.65 / $2,271.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.70 / $1,124.58 / $1,628.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.79 / $701.90 / $1,123.23