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Louisiana 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
$51.03 / $54.17 / $72.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.11 / $52.53 / $58.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.18 / $140.40 / $197.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.53 / $56.01 / $56.01
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 / $59.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.91 / $44.83 / $66.40