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Tennessee 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
$42.49 / $42.49 / $46.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.89 / $43.82 / $74.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.27 / $84.99 / $84.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.00 / $58.60 / $58.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $42.78 / $58.60
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.55 / $437.39 / $437.39
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.70 / $473.70 / $687.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.41 / $45.14 / $63.00