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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
$407.38 / $676.08 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $870.96
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $891.25 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $1,071.52 / $2,137.96