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North Carolina 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
$1,399.02 / $1,399.02 / $2,413.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.12 / $1,399.02 / $1,399.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,280.98 / $1,537.18 / $2,918.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.33 / $1,198.29 / $1,198.29
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $1,399.02 / $1,818.73
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.93 / $1,120.93 / $1,120.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.20 / $2,628.05 / $2,861.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.19 / $789.97 / $1,155.77
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,496.42 / $7,399.97 / $7,399.97
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,000.67 / $11,632.50 / $11,632.50