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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
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,230.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,862.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,148.15 / $3,801.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $7,943.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,258.93 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,047.13