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Washington, DC 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
$27.53 / $41.07 / $41.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.53 / $27.53 / $27.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.08 / $55.08 / $55.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $42.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.19 / $36.19 / $109.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.82 / $45.88 / $58.08