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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

Facilitymedian $120 · 10th–90th $43–$1910%20%10th90th$120Professionalmedian $54 · 10th–90th $32–$740%20%10th90th$54$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$42.66 / $42.66 / $42.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $42.66 / $70.79
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $69.18 / $281.84
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $61.66 / $89.13
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $128.82 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $72.44
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $83.18
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $69.18 / $281.84
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $61.66 / $89.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $52.48 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $54.95 / $70.79