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Kansas 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
$1,309.45 / $1,309.45 / $1,309.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.21 / $857.91 / $1,309.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.19 / $1,265.46 / $1,346.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.73 / $1,328.73 / $1,328.73
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 / $1,115.23 / $2,302.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $1,274.41 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $788.90 / $2,020.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $762.60 / $1,056.58