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Kentucky 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
$38.01 / $39.40 / $39.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.77 / $36.36 / $48.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.50 / $63.45 / $66.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.58 / $29.58 / $54.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.59 / $85.66 / $104.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.93 / $76.14 / $104.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $84.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $57.67 / $284.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.66 / $67.89 / $84.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.54 / $48.81 / $66.98