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Nebraska rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.10 / $43.10 / $43.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.10 / $146.63 / $177.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.75 / $157.75 / $157.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.50 / $55.56 / $56.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $83.83 / $83.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.17 / $82.18 / $158.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.79 / $73.98 / $256.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.56 / $46.63 / $77.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.83 / $84.23 / $129.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.23 / $110.70 / $176.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.56 / $46.63 / $65.68