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Wisconsin 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 $107 · 10th–90th $105$1950%50%10th90th$107Professionalmedian $98 · 10th–90th $63$1580%20%10th90th$98$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
$64.57 / $64.57 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $114.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $177.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $436.52 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $173.78 / $199.53
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $104.71 / $162.18
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $158.49 / $177.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $117.49 / $537.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $102.33 / $223.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $79.43
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $165.96 / $257.04
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $125.89 / $245.47
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $208.93 / $537.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $173.78 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $95.50 / $162.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $151.36