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New Mexico 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
$525.89 / $525.89 / $525.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.42 / $791.02 / $2,557.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,467.94 / $5,258.35 / $8,809.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.67 / $672.89 / $967.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.89 / $1,012.37 / $1,518.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $288.18 / $812.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.52 / $812.83 / $1,054.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.27 / $630.26 / $988.78