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Wisconsin 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$5370%50%90th$347Professionalmedian $347 · 10th–90th $302$3470%50%10th$347$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$630.96
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,412.54
Typical High
$1,819.70
Medica
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$537.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$4,786.30
Median
$4,786.30
Typical High
$4,786.30
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$630.96
Quartz
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$645.65
Typical High
$831.76
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$512.86
United
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$4,786.30
Median
$4,786.30
Typical High
$4,786.30