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Alaska 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

Facilitymedian $39 · 10th–90th $39–$1780%50%90th$39Professionalmedian $98 · 10th–90th $56–$1780%10%10th90th$98$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $93.33 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $199.53
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $54.95 / $177.83
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $177.83 / $275.42
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $177.83 / $186.21
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $177.83 / $186.21
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $173.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $128.82 / $141.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $144.54 / $239.88