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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

Facilitymedian $191 · 10th–90th $186–$3470%20%40%10th90th$191Professionalmedian $174 · 10th–90th $112–$2820%20%10th90th$174$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $114.82 / $204.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $776.25 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $309.03 / $354.81
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $186.21 / $281.84
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $281.84 / $316.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $204.17 / $933.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $181.97 / $389.05
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $331.13
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $295.12 / $457.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $223.87 / $426.58
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $371.54 / $933.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $309.03 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $169.82 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $269.15