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Nebraska 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 $79 · 10th–90th $42–$2750%10%10th90th$79Professionalmedian $46 · 10th–90th $29–$1200%10%20%10th90th$46$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $45.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $45.71 / $120.23
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $60.26 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $89.13 / $169.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $83.18 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $50.12 / $91.20
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $218.78
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $204.17 / $218.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $53.70 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $50.12 / $75.86