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Nebraska rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $131.83 / $912.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $204.17 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $275.42 / $371.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $229.09 / $977.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $104.71 / $208.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $524.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $363.08 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $109.65 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $104.71 / $158.49