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Hawaii 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
$119.56 / $119.56 / $119.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.89 / $267.89 / $267.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.82 / $211.82 / $352.39
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.35 / $335.44 / $335.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.25 / $320.35 / $448.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.66 / $267.89 / $352.39
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.64 / $280.95 / $307.80