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North Carolina 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 $132 · 10th–90th $68–$3470%20%10th90th$132Professionalmedian $115 · 10th–90th $65–$1320%20%10th90th$115$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
$131.83 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $93.33 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $131.83
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 / $138.04
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $131.83 / $204.17
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $89.13 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $97.72 / $141.25
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83