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Idaho 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
$405.71 / $718.81 / $822.97
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 / $812.83 / $866.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $456.42 / $761.94
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.18 / $530.82 / $589.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $819.27 / $973.39
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.62 / $572.62 / $1,050.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.86 / $430.55 / $619.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.27 / $630.26 / $999.59