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Mississippi 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
$149.75 / $149.75 / $238.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.75 / $190.32 / $241.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.00 / $250.00 / $250.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $250.00 / $250.00
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 / $154.63 / $211.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $167.89 / $271.88