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Nationwide rates for HCPCS L0628

Lumbar-Sacral Orthosis Flexible Provides Lumbo-Sacral Support Posterior Extends From Sacro- Coccygeal Juntion To T-9 Vertebra Produces Intra-Cavitary Pressure To Reduce Load On The Inter- Vertebral Discs Includes Straps Closures May Include Stays Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.08 / $41.07 / $53.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.90 / $40.00 / $58.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.86 / $63.45 / $98.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.91 / $54.36 / $61.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $87.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.79 / $49.22 / $71.94