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Minnesota 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
$33.11 / $33.11 / $33.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $33.11 / $43.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $53.70 / $81.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $53.70 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $151.36 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $53.70 / $60.26
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $151.36 / $288.40
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $64.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $40.74 / $173.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $29.51 / $63.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $29.51 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $33.11 / $63.10