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Washington 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 $1,072–$3,8020%10%20%10th90th$1,585Professionalmedian $1,047 · 10th–90th $676–$2,2910%10%10th90th$1,047$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
$1,047.13 / $1,047.13 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $851.14 / $1,412.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,513.56 / $1,513.56
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,737.80
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,089.30 / $4,365.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,995.26 / $3,311.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $1,202.26 / $1,318.26
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,513.56 / $1,584.89
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,778.28
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,290.87 / $3,090.30
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,513.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $2,290.87 / $2,290.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $758.58 / $1,348.96
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,348.96 / $2,398.83