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Ohio 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 $59 · 10th–90th $41$1000%20%40%10th90th$59Professionalmedian $48 · 10th–90th $29$740%20%10th90th$48$0.1$0.5$2.0$10.0$50.0$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
$28.18 / $56.23 / $69.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $53.70
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $58.88 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $58.88 / $93.33
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $69.18
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $53.70 / $75.86
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $57.54 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $57.54
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $57.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $69.18 / $100.00
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $102.33 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $44.67 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $47.86 / $67.61