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Wisconsin 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 $191 · 10th–90th $182$3470%20%40%10th90th$191Professionalmedian $178 · 10th–90th $115$3090%20%40%10th90th$178$0.5$2.0$10.0$50.0$200.0$1.0K

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
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$199.53
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$309.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$213.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$776.25
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$309.03
Typical High
$354.81
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$281.84
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$281.84
Typical High
$316.23
Medica
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$204.17
Typical High
$933.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$181.97
Typical High
$389.05
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$331.13
Network Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$295.12
Typical High
$457.09
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$281.84
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$186.21
Quartz
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$223.87
Typical High
$426.58
Quartz
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$380.19
Typical High
$977.24
Quartz
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$346.74
Typical High
$1,445.44
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$169.82
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$275.42