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Tennessee 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
$124.36 / $124.36 / $135.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.24 / $126.67 / $233.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.97 / $253.93 / $275.95
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.94 / $943.35 / $943.35
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.40 / $1,441.58 / $1,441.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.54 / $166.07 / $231.10