go back

Minnesota 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 $91 · 10th–90th $58–$4570%20%10th90th$91Professionalmedian $78 · 10th–90th $36–$830%20%40%10th90th$78$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
$50.12 / $50.12 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $43.65 / $58.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $83.18 / $117.49
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $234.42 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $81.28 / $91.20
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $229.09 / $457.09
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $97.72
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $61.66 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.72 / $44.67 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $52.48 / $102.33