go back

Michigan 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 $81 · 10th–90th $37–$2190%10%10th90th$81Professionalmedian $44 · 10th–90th $29–$680%20%10th90th$44$0.1$0.5$2.0$10.0$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $37.15 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $37.15 / $54.95
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $162.18 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $56.23
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $41.69
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 / $57.54 / $102.33
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $190.55 / $213.80
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $67.61 / $97.72
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $64.57 / $102.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $51.29 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $47.86 / $70.79