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Arizona 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
Professional
Modifier
Low / Median / High Price
$45.03 / $63.96 / $132.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.31 / $152.85 / $276.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.79 / $141.05 / $192.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $94.02 / $139.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $50.83 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $86.98 / $136.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.73 / $86.98 / $136.46