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Virginia 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
$376.10 / $624.64 / $624.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.10 / $624.64 / $791.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$898.49 / $898.49 / $954.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.43 / $742.43 / $928.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.37 / $840.46 / $840.46
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.83 / $756.64 / $1,189.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $692.15 / $1,290.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,006.59 / $1,290.74 / $1,670.99
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.54 / $988.78 / $1,285.41
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.54 / $988.78 / $1,285.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.05 / $630.26 / $999.59