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Kentucky 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 $95 · 10th–90th $72–$1820%20%10th90th$95Professionalmedian $85 · 10th–90th $62–$1550%10%10th90th$85$50.0$100.0$200.0$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
$72.44 / $72.44 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $72.44 / $107.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $125.89 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $154.88 / $154.88
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $165.96 / $213.80
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $154.88 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $154.88 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $162.18 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $93.33 / $138.04