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Maryland 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 $48 · 10th–90th $30–$580%10%20%10th90th$48Professionalmedian $42 · 10th–90th $27–$680%10%10th90th$42$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $36.31 / $67.61
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $54.95 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $57.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $57.54 / $91.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $43.65 / $57.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $48.98 / $75.86
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $53.70 / $54.95