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Oklahoma rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.15 / $174.15 / $174.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.70 / $174.15 / $277.08
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.32 / $323.54 / $545.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.50 / $322.50 / $338.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $301.51 / $301.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.73 / $182.86 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.19 / $238.04 / $428.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.19 / $225.13 / $346.36