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Missouri 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 $123 · 10th–90th $72–$3090%20%10th90th$123Professionalmedian $89 · 10th–90th $62–$1510%20%10th90th$89$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
$72.44 / $72.44 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $75.86 / $134.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $114.82 / $190.55
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $123.03
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 / $128.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $117.49 / $537.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $97.72 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $93.33 / $138.04