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California 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
Facility
Modifier
Low / Median / High Price
$193.30 / $193.30 / $972.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.80 / $193.30 / $972.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.61 / $233.42 / $403.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.25 / $193.20 / $208.66
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $412.55 / $736.70
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $277.19 / $852.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $211.82 / $267.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $154.63 / $218.17
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.99 / $211.14 / $253.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.88 / $193.95 / $429.46
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.80 / $943.35 / $943.35
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.40 / $1,441.58 / $1,441.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.32 / $419.32 / $419.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.56 / $95.54 / $211.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.38 / $154.63 / $211.82
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.50 / $636.50 / $636.50
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.43 / $211.14 / $274.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $154.02 / $317.45