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Pennsylvania 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
$19.18 / $29.49 / $157.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.18 / $22.44 / $40.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.92 / $39.92 / $53.22
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.61 / $36.56 / $36.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.56 / $38.15 / $42.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $58.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.64 / $36.56 / $69.45
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.02 / $148.60 / $213.62
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.18 / $78.58 / $158.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.17 / $22.44 / $44.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.60 / $28.40 / $92.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.56 / $38.15 / $42.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $59.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $42.03 / $42.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.55 / $42.03 / $42.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.06 / $64.78 / $77.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $32.31 / $53.85