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Washington, DC 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
$26.92 / $26.92 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $33.88 / $58.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $54.95 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $61.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $109.65 / $141.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $48.98 / $63.10