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Nebraska rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.38 / $46.38 / $46.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.38 / $46.38 / $60.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.35 / $59.79 / $60.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $90.22 / $90.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $90.22 / $170.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.09 / $79.61 / $275.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.51 / $50.18 / $78.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.22 / $90.65 / $138.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.61 / $112.20 / $189.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.51 / $50.18 / $69.43