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Kansas 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
$116.28 / $116.28 / $116.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $76.18 / $116.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.83 / $192.83 / $192.83
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 / $128.79 / $173.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $113.96 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $96.86 / $213.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.41 / $96.86 / $151.94