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Florida 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
$143.93 / $159.50 / $190.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.10 / $159.50 / $233.99
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 / $218.17
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.15 / $216.91 / $309.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.52 / $173.52 / $173.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $173.30 / $241.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.20 / $193.20 / $216.91