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Wyoming 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
$899.67 / $899.67 / $1,406.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,568.91 / $1,568.91 / $1,568.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.91 / $1,568.91 / $1,568.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,739.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $814.12 / $1,115.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.10 / $708.22 / $786.26