go back

New Jersey 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
$33.59 / $33.59 / $33.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $38.61 / $54.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $90.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.22 / $61.24 / $90.14
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.67 / $82.04 / $82.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.40 / $49.22 / $81.06