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Mississippi 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
$43.80 / $43.80 / $69.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.80 / $53.45 / $70.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.89 / $61.89 / $61.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.12 / $73.12 / $73.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.12 / $73.12 / $73.12
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 / $83.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $48.23 / $75.66