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Oregon 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
$630.96 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $2,089.30 / $2,570.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $812.83 / $1,096.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $831.76 / $1,122.02
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,096.48
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,047.13 / $1,096.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $870.96 / $1,348.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $933.25 / $1,096.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,479.11 / $4,073.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,174.90 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $1,584.89 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $478.63 / $912.01