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Massachusetts rates for HCPCS L0626

Lumbar Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From L-1 To L-5 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.04 / $40.04 / $184.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.20 / $40.04 / $58.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.53 / $261.07 / $437.39
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.01 / $68.09 / $89.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.08 / $118.36 / $152.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.03 / $66.11 / $66.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.60 / $58.60 / $58.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $58.60 / $108.75
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.20 / $74.20 / $77.92
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.18 / $53.18 / $53.18
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.64 / $437.39 / $437.39
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.89 / $45.73 / $89.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.89 / $47.43 / $89.50