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Tennessee 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
$538.77 / $538.77 / $1,147.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.72 / $549.77 / $870.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.00 / $1,150.00 / $1,273.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.58 / $1,146.42 / $1,310.09
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 / $812.83
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.71 / $3,899.19 / $3,899.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,489.35 / $6,489.35 / $6,489.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.39 / $774.44 / $999.59