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Colorado 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
$23.32 / $23.32 / $23.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.32 / $29.45 / $56.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.65 / $46.80 / $84.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.36 / $54.36 / $54.36
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 / $88.44
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $29.09 / $108.45
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.09 / $29.09 / $29.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.40 / $52.06 / $91.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.90 / $45.05 / $67.87