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Ohio 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
$853.53 / $853.53 / $2,535.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.96 / $853.53 / $977.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,492.19 / $1,748.04 / $4,529.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.23 / $864.22 / $2,065.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.84 / $1,589.13 / $2,145.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.52 / $1,437.95 / $3,402.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,872.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $814.12 / $1,321.33
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,115.23
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $1,115.23 / $1,115.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.53 / $754.42 / $1,110.08