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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
$83.22 / $83.22 / $83.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.53 / $83.22 / $112.53
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.19 / $315.36 / $532.72
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $118.93 / $147.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,379.83 / $7,379.83 / $21,918.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.21 / $123.21 / $131.18
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 / $139.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $154.19 / $161.91
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.52 / $89.52 / $89.52
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.20 / $532.72 / $532.72
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $95.02 / $149.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.47 / $95.02 / $154.19