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Washington 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 $105 · 10th–90th $52–$3020%20%10th90th$105Professionalmedian $78 · 10th–90th $46–$1700%10%10th90th$78$2.0$10.0$50.0$200.0

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
$63.10 / $63.10 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $77.62 / $134.90
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $158.49
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $48.98 / $134.90
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $186.21 / $389.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $154.88 / $302.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $144.54 / $162.18
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $154.88
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $81.28 / $134.90
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $81.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $85.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $54.95 / $134.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $234.42 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $87.10 / $144.54
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $46.77 / $134.90