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Washington rates for HCPCS L0634

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated

Rates data updated July 2026.

Facilitymedian $347 · 10th–90th $347$8320%50%90th$347Professionalmedian $347 · 10th–90th $347$3470%50%$347$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$831.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$75.86
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00