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Missouri rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.16 / $130.16 / $242.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.80 / $134.88 / $205.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.66 / $223.29 / $981.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.44 / $193.20 / $286.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $154.63 / $218.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.54 / $212.66 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $171.51 / $417.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.34 / $171.51 / $271.86