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New Jersey 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
$528.01 / $528.01 / $528.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.01 / $674.97 / $853.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,551.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $814.12 / $1,358.11
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,416.96 / $1,426.92 / $2,031.81
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.27 / $1,551.00 / $1,551.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.05 / $773.78 / $1,423.90