go back

Kansas 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
$853.65 / $1,117.65 / $1,139.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.11 / $559.29 / $853.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.42 / $872.42 / $872.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,097.26 / $1,197.16 / $1,269.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.28 / $1,188.28 / $1,188.28
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 / $1,276.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $838.24 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $712.41 / $1,569.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.95 / $712.41 / $999.59