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Iowa 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

Facilitymedian $79 · 10th–90th $45–$2240%10%20%10th90th$79Professionalmedian $45 · 10th–90th $29–$890%20%10th90th$45$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $41.69 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $89.13 / $107.15
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $97.72 / $104.71
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $107.15 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $61.66 / $147.91
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $97.72 / $107.15
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $169.82 / $169.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $77.62 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $75.86 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $87.10
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $81.28 / $81.28