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Massachusetts rates for HCPCS L0629

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $173.00 / $173.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.00 / $173.00 / $173.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $818.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.02 / $263.02 / $263.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.01 / $221.69 / $263.02
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.73 / $164.73 / $164.73
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $161.19