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Nebraska rates for HCPCS L1845

Knee orthosis (KO), double 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
$587.23 / $587.23 / $587.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.23 / $587.23 / $762.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.62 / $782.71 / $782.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.32 / $890.25 / $899.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $1,012.91 / $1,012.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.51 / $1,012.91 / $1,561.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.65 / $1,009.29 / $4,802.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.58 / $459.39 / $920.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.95 / $1,012.91 / $1,398.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.11 / $1,213.97 / $2,086.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.24 / $1,080.95 / $1,878.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.05 / $459.39 / $707.90