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Massachusetts 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
$40.04 / $40.04 / $40.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.72 / $40.04 / $53.80
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.09 / $173.18 / $256.42
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.84 / $57.24 / $70.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.02 / $292.02 / $867.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.30 / $59.30 / $63.12
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 / $67.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.20 / $74.20 / $77.92
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.94 / $45.94 / $45.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.19 / $256.42 / $256.42
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.84 / $45.73 / $71.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.48 / $45.73 / $75.31