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Indiana 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 $107 · 10th–90th $63–$1660%50%10th90th$107Professionalmedian $78 · 10th–90th $58–$1450%20%10th90th$78$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
$63.10 / $63.10 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $69.18 / $114.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $107.15 / $199.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $114.82 / $186.21
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $158.49 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $151.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $95.50 / $144.54