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Nationwide rates for HCPCS L0637

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, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $891.25 / $3,548.13	Facility	$549.54	$891.25	$3,548.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $794.33 / $1,479.11	Professional	$575.44	$794.33	$1,479.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $776.25 / $2,884.03	Facility	$575.44	$776.25	$2,884.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $794.33 / $1,737.80	Professional	$251.19	$794.33	$1,737.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $912.01 / $6,456.54	Facility	$912.01	$912.01	$6,456.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $2,238.72	Professional	$660.69	$660.69	$2,238.72
United Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $741.31 / $1,737.80	Facility	$478.63	$741.31	$1,737.80
United Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $724.44 / $1,122.02	Professional	$489.78	$724.44	$1,122.02

Nationwide rates for HCPCS L0637

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