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Arizona 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
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.91 / $791.01 / $1,015.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.55 / $1,044.55 / $1,044.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.00 / $202.30 / $365.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.66 / $186.66 / $602.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $593.37 / $1,021.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $372.80 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.39 / $630.26 / $988.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.83 / $630.26 / $988.78