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Arizona rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.73 / $113.25 / $233.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $221.09 / $399.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $204.00 / $277.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $154.63 / $246.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.56 / $90.00 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $154.02 / $241.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $154.02 / $241.63