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Utah rates for HCPCS L0625

Lumbar Orthosis 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 Offthe Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.10 / $19.10 / $19.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.10 / $22.05 / $186.86
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 / $38.15 / $51.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $14.90 / $35.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.56 / $26.56 / $35.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.14 / $23.80 / $38.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.60 / $29.32 / $29.59