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New Hampshire rates for HCPCS L0649

Lumbar-Sacral Orthosis 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 Presssure To Reduce Load On Intervertebral Disc 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
$197.95 / $197.95 / $237.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.83 / $147.34 / $197.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.91 / $216.91 / $257.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.20 / $193.20 / $195.72
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.04 / $273.04 / $842.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.24 / $168.24 / $224.34
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.13 / $253.35 / $360.09