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Tennessee 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
$718.81 / $718.81 / $785.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.97 / $741.41 / $1,345.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$951.94 / $1,437.95 / $1,437.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$829.08 / $1,115.23 / $1,115.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $814.12 / $1,115.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,496.42 / $7,399.97 / $7,399.97
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,000.67 / $8,000.67 / $11,632.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.39 / $780.45 / $1,066.83