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Wyoming 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
Professional
Modifier
Low / Median / High Price
$23.32 / $23.32 / $52.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.44 / $40.44 / $40.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.44 / $40.44 / $40.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $90.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $42.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.72 / $45.05 / $50.02