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Missouri 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
$25.91 / $40.18 / $53.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.44 / $25.91 / $39.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.40 / $40.40 / $41.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.85 / $42.89 / $188.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.35 / $36.19 / $50.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $42.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $42.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.81 / $40.85 / $181.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.80 / $32.95 / $80.27
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.88 / $49.88 / $49.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.78 / $64.78 / $77.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.80 / $32.95 / $48.53