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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
$1,096.48 / $1,174.90 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,778.28 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,621.81 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $794.33 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $2,290.87 / $2,290.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,698.24