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Iowa rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, custom fabricated

Facilitymedian $1,950 · 10th–90th $1,023–$5,1290%20%10th90th$1,950Professionalmedian $977 · 10th–90th $741–$1,9050%20%10th90th$977$2.0$10.0$50.0$200.0$1.0K$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,258.93 / $1,380.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $912.01 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,905.46 / $2,344.23
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,862.09 / $1,995.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $2,290.87 / $8,511.38
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,202.26 / $3,090.30
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,290.87 / $2,570.40
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,238.72 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $3,311.31 / $3,311.31
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,344.23 / $3,630.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $2,041.74 / $4,265.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,000.00 / $1,737.80
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,949.84 / $1,949.84