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Virginia 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
$25.58 / $45.32 / $45.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.58 / $45.32 / $52.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.96 / $58.96 / $62.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.80 / $53.80 / $67.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.22 / $57.73 / $57.73
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 / $55.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.21 / $51.73 / $82.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $50.21 / $85.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.20 / $85.00 / $113.30
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.20 / $71.73 / $93.25
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.20 / $71.73 / $93.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $45.73 / $71.73