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Massachusetts 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
$677.68 / $677.68 / $677.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.68 / $733.60 / $993.37
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,387.69 / $4,418.22 / $7,399.97
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.05 / $1,152.18 / $1,514.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,693.52 / $2,002.83 / $2,579.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.18 / $1,422.08 / $1,422.08
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 / $1,842.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.78 / $1,255.78 / $1,318.57
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.32 / $1,132.32 / $1,132.32
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,225.93 / $7,399.97 / $7,399.97
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.19 / $773.78 / $1,514.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.86 / $829.08 / $1,514.65