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Wisconsin 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

Facilitymedian $51 · 10th–90th $50–$930%50%10th90th$51Professionalmedian $48 · 10th–90th $31–$1120%10%20%10th90th$48$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $33.88 / $151.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $51.29 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $208.93 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $85.11 / $95.50
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $50.12 / $77.62
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $85.11
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $56.23 / $257.04
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $48.98 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $54.95 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $79.43 / $125.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $60.26 / $117.49
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $102.33 / $257.04
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $83.18 / $389.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $46.77 / $77.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $64.57 / $97.72