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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

Facilitymedian $1,585 · 10th–90th $871–$1,8620%20%40%10th90th$1,585Professionalmedian $1,047 · 10th–90th $676–$1,4130%20%10th90th$1,047$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $870.96 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,698.24 / $1,905.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,122.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $2,511.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $707.95 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $933.25 / $1,348.96
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $2,238.72