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West 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
$37.15 / $37.15 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.75 / $37.15 / $52.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.32 / $75.08 / $103.18
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.32 / $41.27 / $70.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $68.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $264.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $46.62 / $76.20