go back

Rhode Island 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
Professional
Modifier
Low / Median / High Price
$83.22 / $109.17 / $117.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.87 / $270.97 / $391.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.88 / $104.35 / $135.18
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 / $128.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $95.02 / $158.36