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Oklahoma rates for HCPCS L0469

Thoracic-lumbar-sacral orthosis (TLSO), sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.98 / $204.98 / $204.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.39 / $204.98 / $230.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $382.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.88 / $382.03 / $382.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.22 / $215.23 / $1,660.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.75 / $266.93 / $480.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.75 / $262.20 / $404.17