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Vermont 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
Professional
Modifier
Low / Median / High Price
$27.84 / $44.73 / $51.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.15 / $74.15 / $74.15
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 / $69.67
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.60 / $58.60 / $58.60
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $58.60 / $69.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.70 / $54.30 / $105.96