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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.13 / $53.13 / $55.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.93 / $36.60 / $68.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.92 / $79.19 / $143.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.80 / $73.06 / $99.56
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 / $42.10 / $72.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $59.83 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.19 / $45.05 / $67.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.68 / $45.05 / $67.87