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North Dakota 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
$1,168.84 / $1,168.84 / $1,168.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,104.16 / $1,104.16 / $1,168.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.14 / $1,776.06 / $1,820.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,842.38 / $1,860.80 / $2,339.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.41 / $1,168.84 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.03 / $786.26 / $1,280.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $786.26 / $1,280.06