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Missouri rates for HCPCS L0634

Lumbar-sacral orthosis (LSO), 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/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $323.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $724.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84