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Wyoming 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
Professional
Modifier
Low / Median / High Price
$15.32 / $15.32 / $34.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.56 / $26.56 / $26.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.56 / $26.56 / $26.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $59.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $38.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.74 / $29.59 / $32.95