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Florida 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
$42.09 / $46.65 / $74.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.53 / $46.65 / $68.44
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 / $63.97
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.07 / $63.45 / $77.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $72.84 / $80.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.19 / $49.63 / $64.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.45 / $72.84 / $72.84