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West Virginia 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
$26.27 / $26.27 / $26.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.44 / $26.27 / $35.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.09 / $53.06 / $72.92
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.09 / $29.17 / $50.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $42.22 / $55.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $38.15 / $186.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.06 / $55.06 / $55.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.80 / $32.31 / $54.09