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Vermont 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
Professional
Modifier
Low / Median / High Price
$19.47 / $46.62 / $53.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.03 / $55.03 / $55.03
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 / $55.62
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $55.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.48 / $60.97 / $110.34