go back

Wyoming 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
$45.03 / $45.03 / $101.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.06 / $78.06 / $78.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.06 / $78.06 / $78.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $174.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $94.02 / $128.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.88 / $86.98 / $96.57