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Indiana 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 $55 · 10th–90th $33–$850%50%10th90th$55Professionalmedian $42 · 10th–90th $30–$720%20%10th90th$42$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
$33.11 / $33.11 / $33.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $36.31 / $67.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $54.95 / $95.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $87.10
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $83.18 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $57.54 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $83.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $44.67 / $67.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $48.98 / $70.79