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Maryland 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 $89 · 10th–90th $62–$1290%10%20%10th90th$89Professionalmedian $81 · 10th–90th $52–$1320%10%10th90th$81$20.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $72.44 / $131.83
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $109.65 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $87.10 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $95.50 / $151.36
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $104.71 / $104.71