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Kansas 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
$295.14 / $295.14 / $295.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.28 / $193.37 / $295.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.63 / $424.01 / $449.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.87 / $420.87 / $420.87
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 / $301.51 / $441.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.73 / $289.29 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.19 / $245.87 / $542.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.86 / $245.87 / $350.16