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Georgia 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 $126 · 10th–90th $74–$4570%20%10th90th$126Professionalmedian $98 · 10th–90th $65–$1780%20%10th90th$98$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
$74.13 / $74.13 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $75.86 / $131.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $213.80
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
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 / $165.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $87.10 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $154.88