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Arizona rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.25 / $222.25 / $222.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.28 / $277.08 / $864.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.17 / $397.17 / $397.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.00 / $202.30 / $365.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.00 / $186.66 / $245.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $220.10 / $353.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.73 / $129.01 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.50 / $220.78 / $346.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.50 / $220.78 / $346.36