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Louisiana 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
$795.33 / $844.28 / $1,137.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.64 / $795.33 / $917.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.35 / $955.35 / $955.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,280.84 / $2,188.15 / $3,075.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.28 / $853.57 / $853.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$844.26 / $844.26 / $844.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $952.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $952.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $698.62 / $999.59