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Tennessee 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
$36.36 / $36.36 / $39.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.88 / $37.04 / $68.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.53 / $74.27 / $80.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.74 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $51.69
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.56 / $275.93 / $275.93
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.15 / $421.74 / $421.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.79 / $48.43 / $67.87