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Oklahoma rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,318.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $4,897.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $758.58 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,621.81 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $1,023.29