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North Dakota 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 / $363.08 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $245.47 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $338.84 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $436.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $363.08 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $251.19 / $407.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $588.84 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $251.19 / $407.38