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Nationwide rates for HCPCS L0638

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, custom fabricated

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $831.76 / $1,778.28	Facility	$630.96	$831.76	$1,778.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $831.76 / $1,412.54	Professional	$660.69	$831.76	$1,412.54
BCBS Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $891.25 / $3,162.28	Facility	$645.65	$891.25	$3,162.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $954.99 / $1,862.09	Professional	$831.76	$954.99	$1,862.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $6,606.93	Facility	$1,122.02	$1,122.02	$6,606.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $2,290.87	Professional	$812.83	$812.83	$2,290.87
United Facility/Professional Facility Modifier Low / Median / High Price $537.03 / $912.01 / $1,949.84	Facility	$537.03	$912.01	$1,949.84
United Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $776.25 / $1,230.27	Professional	$549.54	$776.25	$1,230.27

Nationwide rates for HCPCS L0638

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