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Missouri rates for HCPCS L1840

Knee orthosis (KO), derotation, medial-lateral, anterior cruciate ligament, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $588.84 / $1,288.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $3,801.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $660.69 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $741.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $851.14 / $5,495.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $851.14 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $776.25