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Wisconsin 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 $1,479$3,0200%50%10th90th$1,660Professionalmedian $1,122 · 10th–90th $776$2,5120%20%10th90th$1,122$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
$831.76 / $831.76 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $831.76 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,754.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,548.82 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $3,801.89 / $8,128.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $2,344.23 / $3,162.28
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $1,348.96 / $2,041.74
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,951.21 / $3,715.35
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $1,621.81 / $8,511.38
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $954.99 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,096.48
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $2,630.27 / $2,630.27
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,862.09 / $3,235.94
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,511.89 / $5,011.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $3,311.31 / $10,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,513.56 / $11,220.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $933.25 / $1,659.59
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $812.83 / $1,445.44