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Massachusetts 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
$83.18 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $83.18 / $134.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $134.90 / $537.03
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $120.23 / $165.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $22,387.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $131.83
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $162.18
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $134.90 / $537.03
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $120.23 / $165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $95.50 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $107.15 / $144.54