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Louisiana 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
Facility
Modifier
Low / Median / High Price
$587.39 / $623.54 / $839.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.16 / $587.39 / $677.76
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.00 / $650.00 / $650.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.97 / $1,616.05 / $2,271.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.11 / $771.66 / $771.66
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $702.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $501.36 / $742.45