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Vermont 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
Professional
Modifier
Low / Median / High Price
$48.15 / $48.15 / $55.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.75 / $165.75 / $165.75
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 / $90.07
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $63.68 / $90.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.13 / $57.17 / $114.05