go back

Pennsylvania 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 $195 · 10th–90th $56–$2190%20%10th90th$195Professionalmedian $78 · 10th–90th $56–$1290%20%10th90th$78$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
$56.23 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $74.13 / $117.49
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
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
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $144.54 / $208.93
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $77.62 / $109.65
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $56.23
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $74.13 / $114.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $269.15 / $269.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $123.03 / $138.04
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $123.03 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $194.98 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $95.50 / $158.49