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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
$248.06 / $248.06 / $248.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.50 / $270.00 / $304.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.57 / $373.11 / $578.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.45 / $382.93 / $403.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $935.23 / $2,597.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.25 / $374.45 / $448.63
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.24 / $897.31 / $2,045.30
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.25 / $353.25 / $361.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.72 / $304.83 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.19 / $246.54 / $497.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.19 / $246.91 / $497.29