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Missouri rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.58 / $186.58 / $347.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.42 / $193.37 / $295.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $250.00 / $401.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.83 / $320.08 / $1,407.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.43 / $295.79 / $410.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $220.10 / $321.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.96 / $304.83 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.18 / $245.87 / $599.03
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.07 / $372.07 / $372.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.18 / $245.87 / $506.43