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Missouri rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $41.69 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $56.23 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $67.61 / $100.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $245.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $60.26 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $67.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $64.57 / $338.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $51.29 / $616.60
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $53.70 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $48.98 / $72.44