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Nebraska rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.29 / $227.29 / $227.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.29 / $246.71 / $936.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.41 / $301.41 / $301.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.36 / $293.00 / $295.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $442.07 / $442.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.51 / $441.56 / $835.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.56 / $390.13 / $1,352.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.86 / $245.87 / $385.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.07 / $444.19 / $683.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.19 / $583.80 / $929.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.86 / $245.87 / $346.36