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Florida 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
$81.28 / $90.07 / $107.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.14 / $90.07 / $132.13
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
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.50 / $122.50 / $174.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.00 / $98.00 / $98.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $97.86 / $136.46
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.80 / $111.80 / $122.50