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Washington 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

Facilitymedian $186 · 10th–90th $93–$5370%20%10th90th$186Professionalmedian $138 · 10th–90th $81–$2950%10%10th90th$138$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $134.90 / $239.88
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $275.42
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $87.10 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $213.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $331.13 / $691.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $269.15 / $537.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $257.04 / $281.84
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $269.15
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $144.54 / $239.88
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $144.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $151.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $97.72 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $416.87 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $154.88 / $257.04
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $83.18 / $239.88