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Maine 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
Professional
Modifier
Low / Median / High Price
$18.20 / $28.84 / $100.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $50.12 / $56.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $38.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $43.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $35.48 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $29.51 / $29.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $36.31 / $57.54