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Connecticut 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
$47.96 / $47.96 / $47.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.88 / $43.11 / $54.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.17 / $63.45 / $72.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.36 / $54.36 / $57.66
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 / $63.68
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.24 / $41.24 / $41.24
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.19 / $41.24 / $51.22
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.37 / $57.37 / $57.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.90 / $49.22 / $70.50