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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
$831.76 / $831.76 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $5,623.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $933.25 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $7,943.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,258.93 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $758.58 / $1,122.02