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Virginia 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 $126 · 10th–90th $78–$1910%50%10th90th$126Professionalmedian $100 · 10th–90th $65–$1700%20%10th90th$100$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
$52.48 / $93.33 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $93.33 / $131.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $134.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $234.42
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $128.82 / $204.17
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $104.71 / $186.21
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $117.49 / $158.49
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $147.91 / $251.19
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $147.91 / $251.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $89.13 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $95.50 / $158.49