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Nebraska rates for HCPCS L0643

Lumbar-sacral orthosis (LSO), sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 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
$89.55 / $89.55 / $89.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.55 / $89.55 / $116.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.94 / $115.43 / $116.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $174.15 / $174.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.79 / $173.91 / $329.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.59 / $153.69 / $532.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.41 / $96.86 / $151.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.15 / $175.00 / $269.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $229.99 / $366.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.41 / $96.86 / $136.46