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Michigan rates for HCPCS L0639

Lumbar-sacral orthosis (LSO), sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Facilitymedian $1,122 · 10th–90th $891–$5,8880%20%10th90th$1,122Professionalmedian $794 · 10th–90th $550–$1,5490%20%10th90th$794$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
$891.25 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $776.25 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $4,677.35 / $8,912.51
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,621.81
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,023.29 / $1,548.82
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $2,818.38 / $3,311.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,258.93 / $1,905.46
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,071.52 / $1,412.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,288.25 / $1,737.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $724.44 / $1,047.13