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Idaho rates for HCPCS L1843

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.77 / $712.08 / $923.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.81 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $748.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.04 / $743.27 / $1,055.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.64 / $1,002.40 / $1,055.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $778.70 / $927.39
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.94 / $1,030.43 / $1,545.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.61 / $765.07 / $1,107.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.47 / $481.81 / $737.30