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Utah 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 $41 · 10th–90th $29–$550%20%40%10th90th$41Professionalmedian $43 · 10th–90th $23–$1200%10%10th90th$43$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.85 / $50.12 / $120.23
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 / $57.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $22.91 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $41.69 / $54.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $58.88
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $42.66 / $85.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $42.66 / $63.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $44.67 / $47.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $43.65 / $64.57