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Connecticut 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
$163.90 / $163.90 / $163.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.24 / $146.75 / $163.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.11 / $216.91 / $248.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.20 / $193.20 / $195.72
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 / $211.82
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.99 / $140.99 / $140.99
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.71 / $140.99 / $184.37
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.79 / $154.79 / $154.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $168.24 / $241.00