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Montana 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
$12.39 / $35.61 / $186.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.07 / $53.07 / $53.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $57.18 / $57.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.15 / $57.18 / $57.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.36 / $38.19 / $57.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.18 / $38.15 / $57.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.74 / $29.59 / $45.27