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Oklahoma rates for HCPCS L0643

Lumbar-sacral orthosis (LSO), 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, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.61 / $68.61 / $68.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.06 / $68.61 / $76.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $128.79 / $128.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $72.04 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $93.77 / $168.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $92.11 / $136.46