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Maryland 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
$43.44 / $43.44 / $43.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.51 / $44.85 / $71.64
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.17 / $51.17 / $51.17
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 / $42.78 / $58.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.16 / $91.65 / $131.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.84 / $45.73 / $72.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.27 / $50.27 / $64.16