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California rates for HCPCS L0651

Lumbar-sacral orthosis (LSO), sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.02 / $791.02 / $4,104.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.72 / $791.01 / $1,159.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.46 / $870.46 / $870.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.15 / $958.07 / $1,673.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.00 / $800.91 / $864.98
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,740.59 / $3,108.19
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,158.84 / $3,596.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$854.15 / $854.15 / $1,238.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.53 / $623.53 / $910.56
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.18 / $890.84 / $1,069.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.02 / $812.43 / $1,764.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.07 / $3,899.19 / $3,899.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,489.35 / $6,489.35 / $6,489.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,075.35 / $2,075.35 / $2,075.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $395.76 / $854.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.52 / $623.53 / $854.15
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,685.38 / $2,685.38 / $2,685.38
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.61 / $890.84 / $1,158.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.83 / $630.26 / $1,435.44