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North Dakota 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
$919.14 / $919.14 / $919.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.37 / $791.01 / $919.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.62 / $973.81 / $998.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.13 / $1,031.33 / $1,296.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.61 / $880.88 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.30 / $735.31 / $1,050.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.15 / $699.71 / $1,092.29