go back

Kansas 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
$205.89 / $205.89 / $205.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $134.88 / $205.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.45 / $341.45 / $341.45
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 / $211.82 / $307.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.56 / $201.80 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $171.51 / $378.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.73 / $171.51 / $269.07