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Louisiana 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
$54.91 / $58.28 / $78.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.09 / $54.91 / $63.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.42 / $151.06 / $212.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.46 / $60.28 / $60.28
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $46.61 / $69.43