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North Carolina 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
$68.44 / $68.44 / $153.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.53 / $68.44 / $68.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.45 / $97.76 / $142.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.45 / $61.89 / $68.08
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 / $57.67 / $90.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $68.44 / $102.67
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.28 / $71.28 / $71.28
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.80 / $104.37 / $182.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.72 / $49.27 / $71.56
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.56 / $275.93 / $275.93
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.74 / $421.74 / $421.74