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West 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
$549.16 / $549.16 / $549.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.82 / $583.88 / $791.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.02 / $1,144.08 / $1,572.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.02 / $628.94 / $1,078.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,046.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $4,015.83
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.80 / $718.80 / $864.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.83 / $692.15 / $1,050.44