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Massachusetts 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
$211.21 / $211.21 / $211.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.94 / $211.21 / $288.27
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.98 / $883.06 / $1,352.24
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.18 / $301.88 / $373.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.12 / $915.12 / $2,717.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.52 / $375.18 / $562.57
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 / $353.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.40 / $391.40 / $410.97
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
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.97 / $1,352.24 / $1,352.24
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.18 / $241.17 / $378.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.18 / $242.45 / $397.17