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Missouri rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.08 / $38.08 / $70.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.17 / $39.46 / $60.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.21 / $65.31 / $287.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.08 / $54.36 / $78.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $63.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.79 / $62.21 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.72 / $50.18 / $122.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.45 / $49.73 / $72.72