go back

North Dakota 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
$254.63 / $254.63 / $254.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.05 / $193.30 / $254.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.84 / $235.10 / $240.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.38 / $248.84 / $312.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.43 / $212.66 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.43 / $176.71 / $283.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.28 / $154.02 / $278.86