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Colorado 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
$45.03 / $45.03 / $45.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.03 / $74.13 / $109.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.41 / $90.35 / $164.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.80 / $114.28 / $120.74
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
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $45.03 / $201.10
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.29 / $39.29 / $39.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.70 / $100.51 / $176.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.88 / $86.98 / $136.46