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Montana 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

Rates data updated July 2026.

Facilitymedian $166 · 10th–90th $138$3980%20%10th90th$166Professionalmedian $145 · 10th–90th $65$4170%10%20%10th90th$145$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$131.83
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$295.12
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$295.12
Typical High
$295.12
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$162.18
Typical High
$398.11
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$162.18
Typical High
$398.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$218.78
Typical High
$323.59
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$177.83
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$162.18
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$154.88
Typical High
$245.47