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Vermont 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
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
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
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $309.03 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $380.19 / $741.31