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New Mexico 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 $191 · 10th–90th $35–$7240%10%10th90th$191Professionalmedian $36 · 10th–90th $23–$680%20%10th90th$36$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$35.48 / $35.48 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $33.11 / $56.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $467.74 / $758.58
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $47.86 / $67.61
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $75.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $131.83
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $47.86 / $87.10
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $57.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $48.98 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $44.67 / $67.61