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Illinois 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 $85 · 10th–90th $65–$4370%20%10th90th$85Professionalmedian $79 · 10th–90th $65–$1290%20%40%10th90th$79$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
$64.57 / $64.57 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $72.44 / $109.65
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $263.03 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $79.43 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $138.04
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $213.80
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $85.11 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $97.72 / $151.36