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North Carolina 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
$1,015.24 / $1,015.24 / $1,015.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.76 / $1,015.24 / $1,015.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,529.52 / $1,719.85 / $2,118.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.82 / $955.35 / $1,050.89
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $1,015.24 / $1,290.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.74 / $1,290.74 / $1,290.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.00 / $1,477.90 / $1,548.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.22 / $782.92 / $1,161.67
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.71 / $3,899.19 / $3,899.19
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,489.35 / $6,489.35 / $6,489.35