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Minnesota 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
$739.37 / $739.37 / $739.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.83 / $791.01 / $919.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.01 / $1,138.40 / $1,822.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.75 / $1,168.21 / $1,229.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $2,702.24 / $6,264.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.13 / $1,082.39 / $1,296.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,604.29 / $2,592.67 / $5,909.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.13 / $1,021.13 / $1,044.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.83 / $880.88 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $705.13 / $1,567.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $648.94 / $1,567.44