go back

West 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.08 / $40.00 / $48.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.24 / $80.79 / $111.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.24 / $44.42 / $76.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $84.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $57.67 / $284.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.76 / $49.22 / $82.04