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Wyoming 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
$330.29 / $330.29 / $706.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.62 / $572.62 / $572.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.62 / $572.62 / $572.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,279.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $593.37 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.27 / $630.26 / $699.71