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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
$676.08 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $794.33 / $1,445.44
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,513.56 / $7,413.10
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,174.90 / $1,584.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $1,412.54
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 / $1,122.02
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $2,041.74
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,513.56 / $7,413.10
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,202.26 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $891.25 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,348.96