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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
$724.44 / $794.33 / $1,258.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,288.25
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $11,748.98 / $11,748.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $707.95 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $758.58 / $1,023.29