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Colorado 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
$79.73 / $79.73 / $79.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.73 / $131.27 / $193.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.38 / $159.99 / $290.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.20 / $193.20 / $208.66
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
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.56 / $79.73 / $356.10
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $69.56 / $69.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.94 / $177.99 / $313.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.97 / $154.02 / $241.63