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Tennessee 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 $129 · 10th–90th $76–$5500%20%10th90th$129Professionalmedian $78 · 10th–90th $65–$1320%20%40%10th90th$78$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
$70.79 / $75.86 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $74.13 / $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 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $128.82
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $89.13 / $138.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $93.33 / $128.82