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New Hampshire 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
$870.96 / $870.96 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $812.83 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,698.24 / $1,905.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,122.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $707.95 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $776.25 / $1,348.96
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $2,238.72