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Tennessee 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
$23.45 / $25.70 / $31.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $24.34 / $44.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.77 / $48.80 / $53.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.61 / $38.15 / $42.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $41.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.80 / $181.21 / $181.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.95 / $276.89 / $276.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.21 / $31.04 / $42.45