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Alabama 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
$70.48 / $70.48 / $70.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.85 / $70.48 / $70.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.86 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $83.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $45.05 / $71.94