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Minnesota 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
$1,104.16 / $1,104.16 / $1,104.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.60 / $1,104.16 / $1,168.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,369.62 / $1,696.18 / $2,234.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.30 / $1,509.67 / $1,589.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $4,902.72 / $13,616.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,842.38 / $1,952.92 / $2,339.82
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,910.69 / $4,703.93 / $10,721.99
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,842.38 / $1,842.38 / $1,895.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.93 / $1,589.13 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $790.85 / $1,653.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $708.22 / $1,595.77