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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
$563.16 / $563.16 / $750.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.66 / $583.65 / $890.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.84 / $806.84 / $806.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,075.78 / $1,129.57 / $4,965.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.32 / $584.04 / $870.36
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 / $512.48 / $748.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.72 / $870.75 / $5,034.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.17 / $536.70 / $1,307.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.17 / $536.70 / $816.76