go back

Vermont 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
Professional
Modifier
Low / Median / High Price
$296.82 / $700.52 / $808.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$834.62 / $834.62 / $834.62
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 / $812.83 / $952.31
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $952.31
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $952.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.98 / $916.07 / $1,657.88