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North Dakota 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
$143.79 / $143.79 / $143.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.74 / $109.17 / $143.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.29 / $132.77 / $136.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.13 / $140.52 / $176.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.17 / $120.10 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.73 / $99.79 / $159.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.29 / $86.98 / $157.47