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Utah 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
$311.04 / $311.04 / $311.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.04 / $485.35 / $3,044.44
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 / $702.03 / $748.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.69 / $797.89 / $1,037.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.03 / $1,067.33 / $1,067.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.78 / $765.07 / $1,147.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.17 / $481.81 / $490.25