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Maine 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 $145 · 10th–90th $100–$1660%20%40%10th90th$145Professionalmedian $107 · 10th–90th $63–$1170%20%10th90th$107$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
$56.23 / $83.18 / $114.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
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 / $128.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $128.82
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $83.18 / $114.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $87.10 / $87.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $107.15 / $158.49