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Nebraska rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, 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, anterior panel, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,264.89 / $1,264.89 / $1,264.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,264.89 / $1,264.89 / $1,642.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.29 / $1,917.61 / $1,936.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $2,181.83 / $2,181.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.75 / $2,181.83 / $3,364.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.72 / $2,150.31 / $8,437.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.69 / $989.53 / $1,649.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,175.44 / $2,181.83 / $2,749.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.91 / $2,548.67 / $4,494.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.68 / $981.80 / $1,248.26