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Connecticut 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
$234.95 / $234.95 / $234.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.93 / $234.94 / $277.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.98 / $310.94 / $355.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.55 / $283.76 / $283.76
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 / $301.51
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.11 / $202.11 / $202.11
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.33 / $202.11 / $264.30
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.03 / $232.03 / $232.03
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.03 / $232.03 / $232.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.03 / $241.17 / $345.46