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New York 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 $66 · 10th–90th $42–$1150%20%10th90th$66Professionalmedian $55 · 10th–90th $33–$1050%20%10th90th$55$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$33.11 / $77.62 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $42.66 / $74.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $114.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $147.91
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $72.44 / $72.44
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $97.72
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $93.33 / $218.78
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $60.26 / $109.65
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $69.18
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $60.26 / $66.07
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $53.70 / $79.43
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $52.48 / $158.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $53.70 / $95.50
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $69.18
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $60.26 / $66.07