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Wyoming 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
$162.18 / $245.47 / $831.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $169.82 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $218.78 / $346.74