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Nebraska rates for HCPCS L1852

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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.09 / $447.09 / $447.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.09 / $447.09 / $586.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.09 / $601.09 / $1,202.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.82 / $591.60 / $597.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.29 / $881.60 / $881.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.63 / $881.60 / $1,561.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.09 / $767.40 / $3,006.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.16 / $459.39 / $765.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.60 / $886.50 / $1,935.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.60 / $1,053.97 / $1,935.65
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.85 / $687.28 / $1,255.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.26 / $459.39 / $733.69