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Nebraska rates for HCPCS L0635

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$768.99 / $768.99 / $768.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.99 / $768.99 / $998.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.82 / $1,165.80 / $1,177.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $1,326.44 / $1,326.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.81 / $1,326.44 / $2,045.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$604.14 / $1,319.91 / $5,716.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.51 / $601.58 / $1,002.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,322.57 / $1,326.44 / $1,671.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.90 / $1,567.61 / $2,732.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.15 / $601.58 / $809.59