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Idaho 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
Professional
Modifier
Low / Median / High Price
$18.88 / $51.93 / $54.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $61.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $87.06
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.95 / $41.65 / $69.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.16 / $37.49 / $41.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $59.81 / $71.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.44 / $40.44 / $78.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.16 / $30.40 / $43.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.66 / $45.05 / $71.45