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Maine 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
$601.65 / $835.81 / $835.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$799.12 / $1,035.33 / $1,919.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.43 / $800.91 / $800.91
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 / $593.37 / $812.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.88 / $1,114.88 / $1,114.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.01 / $835.81 / $870.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.98 / $692.15 / $1,579.80