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Ohio 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 $1,660 · 10th–90th $851–$2,7540%20%40%10th90th$1,660Professionalmedian $851 · 10th–90th $676–$1,4450%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
$851.14 / $1,230.27 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $794.33 / $1,096.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,698.24 / $3,467.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $954.99 / $2,089.30
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,348.96 / $1,905.46
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,445.44 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,122.02
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,380.38 / $1,995.26
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,819.70 / $3,311.31
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
$524.81 / $758.58 / $1,071.52