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Kansas 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
$60.23 / $60.23 / $60.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.09 / $39.46 / $60.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.53 / $74.47 / $81.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.14 / $77.14 / $77.14
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 / $90.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $60.23 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $50.18 / $110.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.51 / $48.51 / $67.20