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Nebraska 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
$30.46 / $98.98 / $98.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.46 / $30.46 / $35.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.68 / $39.25 / $39.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $59.25 / $59.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.92 / $58.08 / $112.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.66 / $52.28 / $181.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.05 / $32.95 / $51.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.25 / $59.53 / $90.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.48 / $73.67 / $124.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.06 / $55.06 / $55.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.05 / $32.95 / $44.57