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Maryland 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
Professional
Modifier
Low / Median / High Price
$634.79 / $677.68 / $1,212.47
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.87 / $865.87 / $1,060.26
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 / $814.12 / $1,115.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.70 / $1,551.00 / $2,233.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.10 / $773.78 / $1,233.40
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.48 / $850.48 / $1,085.70