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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
$755.40 / $755.40 / $1,113.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.42 / $755.40 / $851.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.88 / $1,398.88 / $1,398.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,115.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $1,115.23 / $1,115.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $959.50 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $761.47 / $1,580.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $708.22 / $1,016.03