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Tennessee 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
$70.23 / $70.23 / $76.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.34 / $71.53 / $132.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.87 / $143.40 / $155.83
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.29 / $532.72 / $532.72
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.35 / $814.14 / $814.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.23 / $94.23 / $136.46