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Mississippi 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
$84.57 / $84.57 / $134.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.57 / $107.47 / $136.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.18 / $141.18 / $141.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.18 / $141.18 / $141.18
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 / $94.02 / $128.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $94.81 / $153.53