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Louisiana 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
$269.11 / $285.67 / $384.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.32 / $277.08 / $310.51
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.39 / $740.37 / $1,040.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.76 / $295.39 / $295.39
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 / $314.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.19 / $236.38 / $350.16