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Tennessee 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
$508.11 / $508.11 / $555.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.70 / $536.34 / $951.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.90 / $1,016.46 / $1,016.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.71 / $732.96 / $732.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $535.05 / $732.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,764.69 / $5,476.21 / $6,560.56
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,629.62 / $6,629.62 / $8,743.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.63 / $551.67 / $777.26