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Indiana 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
$112.47 / $112.47 / $184.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.32 / $112.47 / $136.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.47 / $164.81 / $184.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.25 / $193.20 / $271.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.52 / $216.91 / $276.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.52 / $202.55 / $248.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.14 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $211.82 / $255.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $166.86 / $241.63