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Idaho rates for HCPCS L0625

Lumbar orthosis (LO), flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.75 / $34.10 / $40.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.39 / $34.10 / $35.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $40.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $40.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.36 / $27.36 / $45.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.52 / $24.62 / $27.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $39.27 / $46.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.56 / $26.56 / $51.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.14 / $19.97 / $28.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.35 / $29.59 / $50.19