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Missouri rates for HCPCS L0643

Lumbar-sacral orthosis (LSO), sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 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
$73.51 / $73.51 / $136.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.97 / $76.18 / $116.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.10 / $126.11 / $554.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $114.28 / $161.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $94.02 / $137.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.96 / $120.10 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $96.86 / $235.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $96.86 / $218.65