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Connecticut 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
$92.57 / $92.57 / $92.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.34 / $82.89 / $92.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $122.50 / $140.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.53 / $111.80 / $111.80
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 / $128.79
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.63 / $79.63 / $79.63
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.86 / $79.63 / $104.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.52 / $89.52 / $89.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $95.02 / $136.10