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New Jersey 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 $68 · 10th–90th $68–$1290%50%90th$68Professionalmedian $83 · 10th–90th $55–$1580%10%10th90th$83$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
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $74.13 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $128.82
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $114.82 / $158.49
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $158.49 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $93.33 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $95.50 / $147.91