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New Hampshire rates for HCPCS L0627

Lumbar Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From L-1 To Below L-5 Vertebra Produces Intra- Cavitary Pressure To Reduce The Load On The Inter-Vertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated 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
$272.18 / $272.18 / $326.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.95 / $211.21 / $293.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.41 / $483.41 / $573.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.12 / $268.12 / $282.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.81 / $312.81 / $312.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.35 / $228.35 / $333.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.40 / $391.40 / $1,208.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.78 / $241.17 / $289.18
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.83 / $379.00 / $570.09