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Utah 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 $933 · 10th–90th $457–$1,6220%20%40%10th90th$933Professionalmedian $1,096 · 10th–90th $457–$6,7610%5%10%10th90th$1,096$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $891.25 / $6,760.83
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 / $812.83 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $1,174.90 / $1,513.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,621.81 / $1,621.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,148.15 / $1,737.80
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,621.81 / $1,621.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,621.81 / $1,905.46
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $707.95 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $707.95 / $1,174.90