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North Carolina 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
Professional
Modifier
Low / Median / High Price
$160.09 / $172.46 / $172.46
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 / $263.02 / $263.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $173.00 / $207.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.21 / $93.21 / $93.21
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $161.19 / $161.19