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Iowa rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Facilitymedian $1,585 · 10th–90th $933–$4,2660%20%10th90th$1,585Professionalmedian $871 · 10th–90th $661–$1,6220%20%10th90th$871$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
$1,000.00 / $1,000.00 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $831.76 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,862.09 / $2,290.87
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,584.89 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,905.46 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $954.99 / $2,630.27
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,819.70 / $2,137.96
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,778.28
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,630.27 / $2,630.27
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,089.30 / $3,467.37
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $1,621.81 / $3,801.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $794.33 / $1,513.56
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,548.82 / $1,548.82