go back

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.07 / $41.07 / $41.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.53 / $36.60 / $52.58
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.08 / $55.08 / $55.08
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 / $57.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.97 / $55.67 / $83.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.72 / $49.22 / $75.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.97 / $54.13 / $54.36