go back

New Hampshire rates for HCPCS L0643

Lumbar-Sacral Orthosis 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 Pendulousabdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.80 / $111.80 / $134.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.38 / $83.22 / $111.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.50 / $122.50 / $145.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.53 / $111.80 / $111.80
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $154.19 / $475.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.47 / $95.02 / $126.71
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.37 / $118.11 / $150.32