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New York 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 $112 · 10th–90th $81$2190%20%40%10th90th$112Professionalmedian $110 · 10th–90th $63$2000%20%10th90th$110$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$67.61 / $147.91 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $81.28 / $114.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $218.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $281.84
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $138.04 / $138.04
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $173.78
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $426.58
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $112.20 / $208.93
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $117.49
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $120.23 / $128.82
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $104.71 / $154.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $102.33 / $309.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $181.97
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $120.23 / $134.90
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $120.23 / $128.82