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Louisiana 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
$187.73 / $199.29 / $268.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.27 / $193.06 / $216.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.33 / $516.50 / $726.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.58 / $206.06 / $206.06
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 / $211.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $164.66 / $244.27