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Missouri rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$827.81 / $827.81 / $1,102.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.78 / $857.91 / $1,309.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,581.30 / $1,660.37 / $7,299.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.90 / $929.30 / $1,300.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,115.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $814.12 / $1,188.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.78 / $1,279.92 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.76 / $788.90 / $1,922.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.76 / $788.90 / $1,200.57