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Vermont 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 $87–$1290%50%10th$129Professionalmedian $93 · 10th–90th $81–$1120%20%10th90th$93$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
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $93.33 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $128.82
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $147.91 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $144.54 / $281.84