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Nebraska rates for HCPCS L2387

Addition to lower extremity, polycentric knee joint, for custom fabricated knee-ankle-foot orthosis (KAFO), each joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.90 / $118.90 / $118.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.90 / $118.90 / $154.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.86 / $180.25 / $182.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $205.08 / $205.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.51 / $205.08 / $333.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.01 / $204.49 / $992.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.98 / $93.02 / $145.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.49 / $205.08 / $283.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.53 / $245.79 / $422.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.23 / $92.18 / $143.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.43 / $93.02 / $140.12