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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 $878.09 / $902.65 / $1,132.27	Facility	$878.09	$902.65	$1,132.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $775.50 / $932.13 / $1,282.81	Professional	$775.50	$932.13	$1,282.81
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,596.38 / $1,900.75 / $3,400.36	Facility	$1,596.38	$1,900.75	$3,400.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $970.78 / $970.78 / $1,445.49	Professional	$970.78	$970.78	$1,445.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,030.36 / $1,030.36 / $1,030.36	Facility	$1,030.36	$1,030.36	$1,030.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $752.17 / $752.17 / $1,893.75	Professional	$752.17	$752.17	$1,893.75
United Facility/Professional Professional Modifier Low / Median / High Price $659.83 / $857.05 / $1,292.38	Professional	$659.83	$857.05	$1,292.38

Nationwide rates for HCPCS L0636

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