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North Dakota 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
$74.48 / $74.48 / $145.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.63 / $54.24 / $74.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.17 / $68.77 / $70.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $72.72 / $91.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.88 / $62.21 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.78 / $50.02 / $81.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.53 / $50.02 / $81.56