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Oklahoma rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.49 / $121.49 / $121.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.99 / $121.49 / $134.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.98 / $224.98 / $224.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $211.82 / $211.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.56 / $127.56 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $166.06 / $299.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $157.06 / $241.63