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Arizona 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
$22.24 / $46.32 / $63.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $57.99 / $57.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.36 / $73.55 / $132.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $67.87 / $92.48
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 / $44.34 / $59.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $24.46 / $256.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $41.86 / $65.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $41.86 / $65.68