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Washington 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 $1,660 · 10th–90th $1,122–$4,1690%20%10th90th$1,660Professionalmedian $1,122 · 10th–90th $776–$2,5700%10%10th90th$1,122$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
$1,096.48 / $1,096.48 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $977.24 / $1,659.59
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,584.89 / $1,584.89
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,412.54 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $2,398.83 / $4,570.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $2,089.30 / $3,715.35
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $1,230.27 / $1,380.38
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,584.89 / $1,621.81
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,621.81 / $1,862.09
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $2,398.83 / $3,235.94
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,584.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,412.54 / $1,819.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $2,630.27 / $2,630.27
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $851.14 / $1,513.56
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,412.54 / $2,454.71