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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$147.34 / $193.30 / $208.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.83 / $479.81 / $692.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.04 / $184.75 / $239.36
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 / $211.82 / $211.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $168.24 / $280.39