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Tennessee 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
$178.27 / $178.27 / $194.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.93 / $186.25 / $318.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.54 / $546.01 / $606.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.69 / $364.01 / $395.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $220.10 / $301.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.01 / $1,352.24 / $1,352.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,058.85 / $2,066.44 / $2,066.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.62 / $239.18 / $346.36