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Ohio 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
$407.28 / $407.28 / $2,357.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.28 / $481.94 / $822.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$922.27 / $922.27 / $922.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.19 / $838.99 / $2,173.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.00 / $817.14 / $1,462.70
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.24 / $1,045.24 / $1,045.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.04 / $763.72 / $1,067.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.90 / $762.72 / $1,633.14
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $952.31
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.00 / $1,089.00 / $1,427.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.95 / $733.00 / $1,038.42