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Nationwide rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, custom fabricated

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $933.25 / $1,819.70	Facility	$724.44	$933.25	$1,819.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $912.01 / $1,659.59	Professional	$724.44	$912.01	$1,659.59
BCBS Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $1,000.00 / $3,801.89	Facility	$724.44	$1,000.00	$3,801.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,000.00 / $2,041.74	Professional	$912.01	$1,000.00	$2,041.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $6,760.83	Facility	$1,023.29	$1,023.29	$6,760.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $758.58 / $2,344.23	Professional	$758.58	$758.58	$2,344.23
United Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $1,023.29 / $2,187.76	Facility	$602.56	$1,023.29	$2,187.76
United Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $870.96 / $1,348.96	Professional	$616.60	$870.96	$1,348.96

Nationwide rates for HCPCS L0636

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