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Ohio 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
$580.66 / $580.66 / $1,956.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.17 / $580.66 / $747.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.82 / $810.82 / $810.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,015.14 / $1,189.20 / $3,081.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.00 / $565.54 / $1,405.41
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.93 / $918.93 / $918.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.82 / $1,081.08 / $1,459.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.50 / $978.23 / $2,314.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $1,273.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $896.84
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $702.03
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $702.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.00 / $379.50 / $497.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.56 / $515.29 / $725.93