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Illinois rates for HCPCS L0643

Lumbar-Sacral Orthosis 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 Pendulousabdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.97 / $65.97 / $65.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.38 / $67.19 / $109.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.65 / $617.97 / $1,347.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.65 / $79.03 / $79.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $174.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $98.00 / $139.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.99 / $161.12 / $213.28
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.19 / $135.19 / $135.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.81 / $126.88 / $133.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $97.36 / $172.40