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Michigan 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 $912–$6,4570%10%20%10th90th$1,950Professionalmedian $851 · 10th–90th $676–$1,5850%20%10th90th$851$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
$912.01 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $831.76 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $4,786.30 / $9,120.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,659.59
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,122.02 / $1,778.28
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $3,019.95 / $3,388.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,288.25 / $1,949.84
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,202.26 / $1,584.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $1,288.25 / $1,949.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $741.31 / $1,122.02