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California 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
Facility
Modifier
Low / Median / High Price
$52.54 / $52.54 / $264.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.75 / $52.53 / $146.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.48 / $63.45 / $109.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.11 / $53.80 / $58.10
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.60 / $112.13 / $200.23
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.54 / $97.06 / $231.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $72.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $44.34 / $59.30
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.37 / $57.38 / $68.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.18 / $52.72 / $116.73
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.60 / $256.42 / $256.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.45 / $391.82 / $391.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.98 / $165.98 / $165.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $25.97 / $52.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.97 / $44.34 / $59.30
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.99 / $172.99 / $172.99
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.78 / $57.38 / $74.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $41.86 / $81.67