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Illinois 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 $115 · 10th–90th $34–$4900%20%10th90th$115Professionalmedian $41 · 10th–90th $32–$680%20%10th90th$41$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$33.88 / $33.88 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $37.15 / $56.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $251.19 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $40.74 / $40.74
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
$41.69 / $41.69 / $72.44
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $97.72 / $125.89
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $97.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $44.67 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $50.12 / $74.13