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California 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
$24.04 / $54.24 / $284.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.17 / $54.24 / $195.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.21 / $48.77 / $117.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.30 / $54.36 / $57.44
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.30 / $116.81 / $208.59
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.33 / $97.40 / $249.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $78.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $72.00
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.16 / $52.74 / $63.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.57 / $56.74 / $125.64
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $275.93 / $275.93
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.15 / $421.74 / $421.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.63 / $178.63 / $178.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.95 / $29.09 / $68.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.56 / $42.10 / $70.38
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.23 / $186.23 / $186.23
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.36 / $52.74 / $68.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.19 / $45.05 / $88.96