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Washington, DC 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
$53.14 / $53.14 / $53.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.14 / $53.14 / $53.14
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.35 / $119.95 / $119.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $94.02 / $94.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.86 / $69.86 / $212.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.34 / $95.02 / $122.24