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Wisconsin 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

Facilitymedian $776 · 10th–90th $759–$1,4130%20%40%10th90th$776Professionalmedian $741 · 10th–90th $457–$1,5140%20%10th90th$741$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $588.84 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $1,288.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $3,548.13 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $1,288.25 / $1,479.11
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $758.58 / $1,288.25
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,230.27 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $870.96 / $3,890.45
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $776.25 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $416.87
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,230.27 / $2,089.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $933.25 / $1,905.46
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $1,548.82 / $3,890.45
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $1,174.90 / $6,456.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $691.83 / $1,174.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $776.25 / $1,230.27