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New Hampshire 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
$281.84 / $281.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $234.42 / $354.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $338.84 / $389.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $302.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $218.78 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $239.88 / $380.19
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $446.68