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Oklahoma rates for HCPCS L0630

Lumbar-Sacral Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulousabdomen Design Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.75 / $92.75 / $136.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.31 / $92.75 / $104.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.75 / $171.75 / $171.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.22 / $112.22 / $112.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.92 / $81.92 / $226.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.16 / $117.81 / $908.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $93.49 / $194.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $86.98 / $124.79