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Louisiana 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
$112.20 / $112.20 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $81.28 / $123.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $288.40 / $407.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $102.33 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $93.33 / $138.04