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Minnesota 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
$173.05 / $173.05 / $173.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $173.05 / $254.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.56 / $260.30 / $403.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.97 / $272.77 / $281.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $652.79 / $1,813.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.38 / $261.16 / $312.89
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.56 / $626.33 / $1,427.64
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.38 / $246.38 / $252.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.66 / $212.66 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $171.99 / $346.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $171.99 / $346.95