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Idaho 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
$17.54 / $48.25 / $52.53
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 / $30.78 / $50.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.37 / $34.83 / $38.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.57 / $66.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.58 / $37.58 / $72.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.09 / $28.25 / $40.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $41.86 / $66.40