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Nationwide rates for HCPCS L0643

Lumbar-sacral orthosis (LSO), sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $83.18 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $81.28 / $131.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $147.91 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $114.82 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $173.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $95.50 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $95.50 / $144.54