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Nebraska rates for HCPCS L1840

Knee Orthosis Derotation Medial-Lateral Anterior Cruciate Ligament Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.79 / $676.79 / $676.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.79 / $676.79 / $878.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.75 / $1,026.03 / $1,036.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $1,167.39 / $1,167.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.58 / $1,313.63 / $1,800.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.66 / $1,163.98 / $5,476.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.18 / $529.46 / $882.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,163.98 / $1,167.39 / $1,573.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.00 / $1,399.13 / $2,405.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,082.49 / $1,237.78 / $2,164.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,173.99 / $1,173.99 / $1,173.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.85 / $529.46 / $778.47