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Indiana 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
$30.57 / $30.57 / $50.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.72 / $30.57 / $46.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.33 / $57.33 / $57.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $44.79 / $50.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.48 / $55.61 / $74.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.54 / $58.96 / $75.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.54 / $55.06 / $67.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.05 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $69.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.91 / $45.73 / $65.68