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Arizona 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

Facilitymedian $60 · 10th–90th $24–$1700%10%10th90th$60Professionalmedian $43 · 10th–90th $29–$740%20%10th90th$43$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $41.69 / $70.79
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $91.20 / $169.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $83.18 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $57.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $53.70 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $44.67 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $48.98 / $50.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $67.61