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Missouri rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.78 / $189.78 / $252.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.78 / $196.68 / $300.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.52 / $380.65 / $1,673.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.49 / $175.24 / $293.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $225.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $164.47 / $232.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.41 / $287.73 / $1,533.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.57 / $180.86 / $440.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.64 / $383.64 / $460.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.57 / $175.21 / $262.07