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Louisiana 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
$863.42 / $916.55 / $1,234.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.96 / $916.55 / $996.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,390.51 / $2,375.46 / $3,339.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.27 / $1,134.27 / $1,134.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $1,115.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $736.89 / $1,091.33