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Wisconsin 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 $1,622 · 10th–90th $1,445–$2,9510%50%10th90th$1,622Professionalmedian $1,047 · 10th–90th $708–$2,4550%20%10th90th$1,047$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
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $794.33 / $1,174.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $2,691.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,513.56 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $3,715.35 / $7,943.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $2,290.87 / $3,090.30
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,318.26 / $1,995.26
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,949.84 / $2,398.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,584.89 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $831.76 / $1,778.28
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,071.52
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $2,570.40
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,819.70 / $3,162.28
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,454.71 / $4,466.84
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $3,235.94 / $7,413.10
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,621.81 / $7,943.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $831.76 / $1,621.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $794.33 / $1,348.96