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Vermont 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
$100.00 / $151.36 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $213.80
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $218.78 / $263.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $263.03 / $524.81