go back

Missouri rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$836.43 / $836.43 / $1,114.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.32 / $866.85 / $1,323.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,597.78 / $1,677.67 / $7,375.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.44 / $874.87 / $1,292.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $897.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $655.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.86 / $1,287.69 / $7,517.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.73 / $797.11 / $1,942.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.73 / $797.11 / $1,181.65