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Montana 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 $1,000–$1,9500%20%40%10th90th$1,585Professionalmedian $933 · 10th–90th $525–$1,9500%10%10th90th$933$100.0$200.0$500.0$1.0K$2.0K$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
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $891.25 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,698.24 / $1,698.24
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,584.89 / $3,090.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,584.89 / $3,090.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,348.96 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,258.93 / $1,698.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $891.25 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $707.95 / $1,071.52