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Wisconsin 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 $55 · 10th–90th $54$1100%50%10th90th$55Professionalmedian $51 · 10th–90th $33$830%20%10th90th$51$0.1$0.5$2.0$10.0$50.0$200.0

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 / $33.11 / $33.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $33.88 / $58.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $239.88 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $89.13 / $102.33
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $53.70 / $83.18
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $114.82 / $158.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $61.66 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $52.48 / $97.72
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $63.10 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $77.62 / $134.90
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $66.07 / $125.89
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $109.65 / $275.42
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $85.11 / $426.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $50.12 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $50.12 / $75.86