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Arizona 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 $115 · 10th–90th $39–$3310%10%10th90th$115Professionalmedian $83 · 10th–90th $56–$1380%20%10th90th$83$0.2$1.0$5.0$20.0$100.0$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
$54.95 / $81.28 / $131.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $173.78 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $162.18 / $309.03
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 / $128.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $66.07 / $363.08
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $87.10 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $95.50 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $138.04