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Minnesota 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 $178 · 10th–90th $117–$8710%10%20%10th90th$178Professionalmedian $151 · 10th–90th $74–$1580%20%40%10th90th$151$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
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $83.18 / $117.49
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $158.49 / $229.09
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $158.49 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $446.68 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $158.49 / $177.83
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $446.68 / $870.96
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $190.55
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $120.23 / $537.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $186.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.38 / $87.10 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $102.33 / $199.53