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Nationwide rates for HCPCS L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $676.08 / $1,148.15	Facility	$398.11	$676.08	$1,148.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $707.95 / $1,584.89	Professional	$407.38	$707.95	$1,584.89
BCBS Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $1,071.52 / $2,630.27	Facility	$831.76	$1,071.52	$2,630.27
BCBS Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $794.33 / $1,479.11	Professional	$741.31	$794.33	$1,479.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $812.83 / $3,630.78	Facility	$812.83	$812.83	$3,630.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $588.84 / $1,288.25	Professional	$588.84	$588.84	$1,288.25
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $691.83 / $1,445.44	Facility	$489.78	$691.83	$1,445.44
United Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $741.31 / $1,047.13	Professional	$446.68	$741.31	$1,047.13

Nationwide rates for HCPCS L0650

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