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Massachusetts 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
$147.34 / $147.34 / $147.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.56 / $147.34 / $199.29
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.54 / $558.37 / $943.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $210.59 / $260.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,077.73 / $1,077.73 / $3,200.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.17 / $218.17 / $232.26
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 / $246.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.04 / $273.04 / $286.69
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.79 / $154.79 / $154.79
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.46 / $943.35 / $943.35
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $168.24 / $263.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $168.24 / $277.07