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Maine rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.11 / $59.89 / $59.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.43 / $73.11 / $135.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.36 / $57.66 / $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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.89 / $79.89 / $79.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.24 / $59.89 / $59.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.82 / $49.22 / $113.20