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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

Facilitymedian $166 · 10th–90th $138–$3980%20%10th90th$166Professionalmedian $138 · 10th–90th $65–$2950%10%10th90th$138$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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $117.49 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $295.12 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $295.12 / $302.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $162.18 / $398.11
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $162.18 / $398.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $218.78 / $323.59
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $177.83 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $154.88 / $245.47