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Massachusetts 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
$601.65 / $601.65 / $601.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.92 / $601.65 / $844.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.79 / $2,191.37 / $3,899.19
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.39 / $862.18 / $1,063.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,478.55 / $1,778.12 / $2,289.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.69 / $1,354.04 / $1,702.19
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 / $1,021.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.88 / $1,114.88 / $1,170.61
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.94 / $715.94 / $862.18
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,830.35 / $3,899.19 / $3,899.19
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.39 / $686.96 / $1,077.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.39 / $734.15 / $1,080.91