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New York 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
$447.92 / $549.77 / $1,017.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.92 / $612.41 / $883.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.33 / $804.10 / $1,576.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.43 / $742.43 / $1,936.39
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.06 / $962.43 / $962.43
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.43 / $962.43 / $962.43
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 / $952.31
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $788.33 / $1,773.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.76 / $652.35 / $1,418.99
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.01 / $749.01 / $749.01
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.01 / $798.93 / $848.86
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.46 / $786.46 / $786.46
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$858.22 / $858.22 / $858.22
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $812.83 / $952.31
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $780.80 / $1,276.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $648.54 / $1,137.46
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.93 / $798.93 / $798.93
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.01 / $798.93 / $848.86