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Virginia 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 $65 · 10th–90th $43–$1290%20%40%10th90th$65Professionalmedian $51 · 10th–90th $33–$850%20%10th90th$51$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
$26.92 / $47.86 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $47.86 / $67.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $69.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $112.20
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $54.95 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $57.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $67.61 / $107.15
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $66.07 / $100.00
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $58.88 / $102.33
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $61.66 / $81.28
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $75.86 / $288.40
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $75.86 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $48.98 / $77.62