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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

Rates data updated July 2026.

Facilitymedian $162 · 10th–90th $93$4900%20%10th90th$162Professionalmedian $112 · 10th–90th $79$3630%10%20%10th90th$112$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
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$112.20
Typical High
$416.87
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$186.21
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$97.72
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$213.80
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$309.03
Typical High
$691.83
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$251.19
Typical High
$512.86
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$234.42
Typical High
$281.84
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$269.15
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$239.88
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$144.54
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$95.50
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$97.72
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$416.87
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$154.88
Typical High
$257.04
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$83.18
Typical High
$239.88