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Minnesota 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
$97.74 / $97.74 / $97.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $97.74 / $143.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.12 / $147.02 / $227.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.06 / $150.88 / $158.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $368.30 / $1,022.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.13 / $147.47 / $176.69
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.66 / $353.37 / $805.45
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.13 / $139.13 / $142.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.47 / $120.10 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $97.13 / $195.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $96.57 / $195.97