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Illinois 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 $1,950 · 10th–90th $813–$8,7100%20%10th90th$1,950Professionalmedian $832 · 10th–90th $676–$1,6220%20%40%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
$812.83 / $812.83 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $812.83 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,981.07 / $10,964.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,202.26 / $1,202.26
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
$812.83 / $812.83 / $1,737.80
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,737.80 / $2,137.96
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $1,288.25 / $2,290.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $794.33 / $1,318.26