go back

Illinois rates for HCPCS L0625

Lumbar Orthosis 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 Offthe Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.44 / $31.98 / $84.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.18 / $22.85 / $35.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.97 / $181.50 / $417.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.95 / $26.88 / $26.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $59.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $38.15 / $54.87
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.36 / $65.33 / $86.31
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.98 / $45.98 / $45.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.19 / $43.14 / $45.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.36 / $77.73 / $144.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.08 / $33.11 / $58.64