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Nationwide rates for HCPCS L0639

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 Providedby Overlapping Rigid Material And Stabilizing Closures Includes Straps Closures May Include Soft Interface Pendulous Abdomen Design Pre- Fabricated Item That Has Been (Revised 01/01/14)

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $775.34 / $775.34 / $919.14	Facility	$775.34	$775.34	$919.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $608.41 / $772.56 / $1,084.56	Professional	$608.41	$772.56	$1,084.56
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,263.33 / $1,499.39 / $2,577.19	Facility	$1,263.33	$1,499.39	$2,577.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $770.62 / $770.62 / $1,155.73	Professional	$770.62	$770.62	$1,155.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,014.49 / $1,014.49 / $1,014.49	Facility	$1,014.49	$1,014.49	$1,014.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $740.58 / $991.73 / $1,081.50	Professional	$740.58	$991.73	$1,081.50
United Facility/Professional Professional Modifier Low / Median / High Price $525.22 / $686.96 / $1,050.44	Professional	$525.22	$686.96	$1,050.44

Nationwide rates for HCPCS L0639

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