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Tennessee 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
$489.01 / $489.01 / $534.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.03 / $513.89 / $675.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.87 / $302.87 / $302.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.60 / $978.23 / $978.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.02 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $702.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.32 / $5,034.28 / $5,034.28
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,442.94 / $5,442.94 / $7,913.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $521.96 / $725.77