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Missouri 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
$562.34 / $562.34 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $1,445.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $812.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $3,801.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $588.84 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $707.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $870.96 / $5,011.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $537.03 / $5,495.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $851.14 / $1,023.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $524.81 / $776.25