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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
$677.68 / $852.61 / $919.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,192.90 / $2,961.79 / $3,506.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.32 / $873.32 / $1,402.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,115.23
Cigna
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
$600.24 / $773.78 / $1,289.63