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Mississippi rates for HCPCS L0633

Lumbar-Sacral Orthosis Sagittal-Coronal Control With Rigid Posterior Frame/Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Lateral Strength Provided By Rigid Lateral Frame/Panels Produces Intracavitary Pressure To Reduce Load On Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.68 / $194.68 / $310.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.74 / $222.05 / $310.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.19 / $269.19 / $269.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.19 / $269.19 / $269.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.91 / $192.91 / $192.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.82 / $140.82 / $192.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $164.92 / $258.69