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Montana 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 $93 · 10th–90th $78–$2240%20%10th90th$93Professionalmedian $78 · 10th–90th $36–$1700%10%10th90th$78$20.0$50.0$100.0$200.0

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
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $67.61 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $169.82
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $91.20 / $223.87
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $91.20 / $223.87
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $128.82 / $186.21
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $102.33 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $93.33 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $87.10 / $138.04