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Oregon 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
$173.78 / $173.78 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $263.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $263.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $190.55 / $190.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19