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Maine 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
Professional
Modifier
Low / Median / High Price
$28.30 / $39.31 / $39.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.06 / $48.02 / $89.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.19 / $37.85 / $37.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $38.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $38.15 / $41.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.44 / $52.44 / $52.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.61 / $39.31 / $39.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.54 / $32.31 / $74.30