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Mississippi 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
$649.75 / $649.75 / $1,035.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.28 / $791.01 / $1,035.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $955.35 / $1,273.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.13 / $1,123.13 / $1,123.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.13 / $1,123.13 / $1,123.13
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 / $593.37 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $782.92 / $1,302.66