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Alaska 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
Professional
Modifier
Low / Median / High Price
$81.05 / $81.05 / $81.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $63.68 / $90.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $29.09 / $29.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.55 / $89.03 / $140.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.27 / $91.27 / $91.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $29.09 / $57.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $63.68 / $90.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.69 / $94.35 / $123.06