go back

Alaska rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), 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 padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.53 / $75.29 / $75.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $55.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $18.91 / $18.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.67 / $82.72 / $130.61
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.97 / $38.97 / $84.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.09 / $84.79 / $184.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $18.91 / $52.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $65.27 / $101.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.30 / $87.64 / $114.32