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Maine 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 $76 · 10th–90th $52–$870%20%10th90th$76Professionalmedian $54 · 10th–90th $33–$660%20%10th90th$54$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
$28.84 / $42.66 / $151.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $75.86 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
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 / $57.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $66.07
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $43.65 / $58.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $44.67 / $44.67
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $54.95 / $83.18