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Missouri rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.38 / $35.38 / $65.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.75 / $36.67 / $55.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.80 / $60.69 / $266.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.89 / $55.61 / $77.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $44.34 / $59.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.97 / $57.80 / $256.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.84 / $46.63 / $113.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.84 / $46.63 / $73.90