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Alabama 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
$136.10 / $136.10 / $136.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.84 / $136.10 / $136.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.18 / $138.18 / $138.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.99 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $128.79 / $144.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $88.70 / $136.46