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Illinois rates for HCPCS L0642

Lumbar Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From L-L To Below L-5 Vertebra Produces Intra- Cavitary Pressure To Reduce Load On The Inter- Vertebral 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
$167.42 / $167.42 / $167.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.10 / $186.02 / $288.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.31 / $302.31 / $350.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.05 / $1,568.45 / $3,421.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.26 / $200.60 / $200.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $442.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $248.75 / $353.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.95 / $448.72 / $646.50
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.14 / $343.14 / $343.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.37 / $321.95 / $338.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.71 / $247.06 / $426.36