HCPCS L0639 at MultiCare Good Samaritan Hospital

Lumbar-sacral orthosis, 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

MultiCare Good Samaritan Hospital, Puyallup

Description from CMS's HCPCS Level II code file.

What MultiCare Good Samaritan Hospital publishes for this code: as an outpatient

MultiCare Good Samaritan Hospital’s prices for HCPCS L0639, as an outpatient
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Commercial insuranceInsurer rates	$1,311 – $5,82512 plans	—
Medicare AdvantageInsurer rates	$1,321 – $1,4537 plans	—
Cash pricePaying yourself, without insurance	—	—
List priceBefore any discount; few people pay it	—	—

Lowest and highest amounts MultiCare Good Samaritan Hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. Its price file is dated 2026-08-27. This is one line of a bill; most care brings several.

Bills to expect

The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in the rest of Washington for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.

Bills to expect for HCPCS L0639 at MultiCare Good Samaritan Hospital
Bill	What it’s for	Original Medicare allows	Private plan estimate
Hospital's feeThe hospital	The service	—	The price above

Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.

Compare HCPCS L0639 at every Washington hospital, with Medicare’s reference amounts.