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Nebraska rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.42 / $1,008.42 / $1,008.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.42 / $1,008.42 / $1,309.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.81 / $1,528.80 / $1,544.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,739.43 / $1,739.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.23 / $1,739.43 / $2,682.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.16 / $1,714.31 / $7,399.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.66 / $788.90 / $1,314.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,734.34 / $1,739.43 / $2,191.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,446.31 / $2,055.69 / $3,583.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.94 / $788.90 / $1,065.76