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Wisconsin rates for HCPCS L0635

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

Facilitymedian $1,230 · 10th–90th $1,096–$2,2390%20%40%10th90th$1,230Professionalmedian $832 · 10th–90th $537–$1,8620%20%10th90th$832$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $602.56 / $831.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $2,041.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $2,818.38 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $1,737.80 / $2,344.23
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $1,000.00 / $1,513.56
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,479.11 / $1,819.70
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $1,202.26 / $5,754.40
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $630.96 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $812.83
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,380.38 / $2,398.83
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,862.09 / $3,388.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $2,454.71 / $6,760.83
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $1,047.13 / $8,912.51
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $630.96 / $1,230.27
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $602.56 / $1,023.29