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Wisconsin rates for HCPCS L0641

Lumbar Orthosis 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
$31.16 / $31.16 / $31.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.16 / $42.46 / $65.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.05 / $55.06 / $91.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.55 / $50.05 / $62.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.56 / $107.11 / $107.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $185.74 / $239.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $82.86 / $94.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $46.74 / $60.06
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.97 / $50.05 / $60.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.16 / $57.80 / $256.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.86 / $49.26 / $89.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.41 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.91 / $47.03 / $60.06
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.97 / $50.05 / $60.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.05 / $60.74 / $114.66
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $97.18 / $256.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $390.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.44 / $76.44 / $76.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.44 / $76.44 / $76.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.89 / $46.85 / $78.09