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Nebraska rates for HCPCS L1851

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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.25 / $486.28 / $486.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.28 / $486.28 / $631.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.54 / $671.54 / $671.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.76 / $620.14 / $626.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $984.92 / $984.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.97 / $965.75 / $1,824.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.28 / $826.68 / $3,153.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.27 / $536.70 / $857.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$984.92 / $989.89 / $2,233.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.92 / $1,200.02 / $2,261.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.99 / $720.43 / $1,316.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.27 / $536.70 / $769.49