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Minnesota 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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $245.47 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $407.38 / $616.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $407.38 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,148.15 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $398.11 / $446.68
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,122.02 / $2,137.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $478.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $302.00 / $575.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $218.78 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $218.78 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $239.88 / $467.74