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New Hampshire 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
$55.55 / $55.55 / $66.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $43.11 / $56.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.45 / $63.45 / $75.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.36 / $54.36 / $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 / $246.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.64 / $49.22 / $58.44
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.05 / $78.06 / $114.75