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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
$365.00 / $365.00 / $365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.06 / $277.08 / $365.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.02 / $337.00 / $345.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.25 / $356.78 / $448.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.57 / $304.83 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.87 / $253.31 / $405.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.11 / $245.11 / $399.73