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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
$1,096.48 / $1,096.48 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,318.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,584.89 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $6,025.60 / $14,125.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,089.30 / $2,344.23
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,888.44 / $11,220.18
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,584.89 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $707.95 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $794.33 / $1,949.84