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Oklahoma rates for HCPCS L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on 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
$507.11 / $507.11 / $507.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.33 / $507.11 / $791.01
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.77 / $948.02 / $948.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.09 / $939.09 / $939.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $952.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $952.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.18 / $532.47 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $701.43 / $1,266.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.18 / $630.26 / $988.78