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California 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 $158 · 10th–90th $126$3980%20%40%10th90th$158Professionalmedian $95 · 10th–90th $63$2340%10%20%10th90th$95$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
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $91.20 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $158.49 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $112.20 / $162.18
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $288.40 / $446.68
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $169.82 / $234.42
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
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $120.23 / $144.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $144.54 / $257.04
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $66.07 / $158.49
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $93.33 / $128.82
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $123.03 / $204.17
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $87.10 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $93.33 / $162.18