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Washington 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 $62 · 10th–90th $28–$1410%10%10th90th$62Professionalmedian $42 · 10th–90th $23–$910%10%10th90th$42$1.0$5.0$20.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $36.31 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $39.81 / $69.18
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $81.28
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $25.70 / $70.79
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $85.11 / $194.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $74.13 / $147.91
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $75.86 / $83.18
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $41.69 / $77.62
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $36.31 / $81.28
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $41.69 / $64.57
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $41.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $43.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $28.84 / $70.79
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $120.23 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $44.67 / $72.44
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $24.55 / $72.44