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Vermont 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
$660.69 / $851.14 / $933.25
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 / $1,174.90
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,513.56 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,071.52 / $3,235.94