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Wisconsin 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

Facilitymedian $40 · 10th–90th $35$830%20%40%10th90th$40Professionalmedian $33 · 10th–90th $21$550%20%10th90th$33$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $83.18 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $21.88 / $38.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $36.31 / $60.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $154.88 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $60.26 / $67.61
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $35.48 / $74.13
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $66.07 / $89.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $39.81 / $181.97
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $34.67 / $64.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $58.88 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $42.66 / $83.18
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $72.44 / $181.97
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $64.57 / $275.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $33.11 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $33.11 / $52.48