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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$43.11 / $54.24 / $58.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.32 / $140.35 / $202.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.22 / $55.55 / $70.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $90.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.90 / $49.22 / $82.04