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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $2,398.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $3,090.30 / $3,630.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $870.96 / $1,659.59
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $870.96 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,288.25