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California 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
Facility
Modifier
Low / Median / High Price
$791.02 / $791.02 / $4,104.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.72 / $791.01 / $1,492.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.02 / $764.28 / $1,160.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.15 / $958.07 / $1,673.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.00 / $742.43 / $815.62
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,740.59 / $3,108.19
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,158.84 / $3,596.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,238.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $593.37 / $952.31
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.18 / $890.84 / $1,069.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.02 / $812.43 / $1,764.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.07 / $3,899.19 / $3,899.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,489.35 / $6,489.35 / $6,489.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,075.35 / $2,075.35 / $2,075.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $395.76 / $812.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.52 / $593.37 / $812.83
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,685.38 / $2,685.38 / $2,685.38
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.61 / $890.84 / $1,158.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.83 / $630.26 / $1,267.81