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Nebraska rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.56 / $158.56 / $158.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.56 / $158.56 / $205.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.81 / $204.40 / $206.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $308.39 / $308.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.82 / $307.97 / $583.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.69 / $272.14 / $943.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.73 / $171.51 / $269.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.39 / $309.87 / $476.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.87 / $407.25 / $648.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.73 / $171.51 / $285.85