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Tennessee 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
$33.79 / $33.79 / $36.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.40 / $35.32 / $59.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.27 / $69.03 / $75.02
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 / $44.34 / $52.17
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.58 / $256.42 / $256.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.45 / $391.82 / $391.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.84 / $45.14 / $65.68