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Oklahoma rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.54 / $35.54 / $70.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $35.54 / $39.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.53 / $65.81 / $65.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $90.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $57.71 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $48.43 / $90.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $45.05 / $64.64