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Minnesota 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.69 / $139.69 / $822.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.76 / $139.69 / $139.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.02 / $263.02 / $263.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.50 / $263.02 / $263.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.19 / $173.00 / $178.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.21 / $614.21 / $614.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.21 / $614.21 / $614.21