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Nationwide rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $44.67 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $41.69 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $54.95 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $54.95 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $91.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $50.12 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $48.98 / $70.79