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Vermont rates for HCPCS L0639

Lumbar-Sacral Orthosis Sagittal-Coronal Control Rigid Shell(S)/Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Anterior Extends From Symphysis Pubis To Xyphoid Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Overall Strength Is Providedby Overlapping Rigid Material And Stabilizing Closures Includes Straps Closures May Include Soft Interface Pendulous Abdomen Design Pre- Fabricated Item That Has Been (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.96 / $671.96 / $775.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,014.49 / $1,014.49 / $1,014.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.58 / $1,014.49 / $1,081.50
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,014.49 / $1,014.49 / $1,014.49
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.58 / $1,014.49 / $1,081.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.98 / $1,034.81 / $1,144.94