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Massachusetts 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
$43.11 / $43.11 / $43.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.17 / $43.11 / $58.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $215.03 / $275.93
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.94 / $57.17 / $73.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.74 / $127.41 / $164.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.14 / $66.72 / $66.72
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.89 / $79.89 / $83.88
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.37 / $57.37 / $57.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.84 / $275.93 / $275.93
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.32 / $49.22 / $76.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.82 / $49.22 / $81.06