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Nebraska rates for HCPCS L1843

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.05 / $686.05 / $686.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.03 / $686.05 / $890.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.84 / $806.84 / $806.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.50 / $1,040.05 / $1,050.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $1,183.35 / $1,183.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.03 / $1,183.35 / $1,824.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.62 / $1,170.31 / $5,034.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.23 / $536.70 / $894.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.91 / $1,183.35 / $1,491.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.00 / $1,398.51 / $2,437.92
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.08 / $1,181.00 / $2,194.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.10 / $536.70 / $727.02