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Nevada 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
$16.36 / $16.36 / $18.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.36 / $18.88 / $42.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.95 / $27.95 / $27.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.91 / $54.36 / $57.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $72.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $72.00
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.96 / $47.03 / $82.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.15 / $45.05 / $65.92