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Minnesota 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
$50.63 / $50.63 / $50.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $50.63 / $74.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.54 / $76.14 / $117.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.81 / $78.15 / $82.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $190.36 / $528.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $76.31 / $91.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.01 / $182.64 / $416.30
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $72.00 / $73.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.96 / $62.21 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $50.41 / $101.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $50.41 / $101.48