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Pennsylvania 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
$46.21 / $175.00 / $307.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.07 / $45.81 / $111.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.34 / $67.40 / $89.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.58 / $68.11 / $68.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.14 / $67.14 / $76.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.01 / $49.01 / $78.75
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.66 / $68.11 / $129.41
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.00 / $145.63 / $406.89
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.68 / $60.99 / $70.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.21 / $174.90 / $349.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.69 / $45.73 / $108.98
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.90 / $100.80 / $169.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.14 / $67.14 / $76.52
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.01 / $49.01 / $78.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.29 / $74.47 / $74.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.29 / $74.47 / $77.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.69 / $52.15 / $86.92