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New Hampshire 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
$808.30 / $808.30 / $969.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.77 / $601.65 / $808.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$898.49 / $898.49 / $1,065.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.43 / $742.43 / $800.91
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 / $866.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.88 / $1,114.88 / $3,441.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.98 / $686.96 / $916.07
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.94 / $1,034.52 / $1,470.33