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West Virginia 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
$545.12 / $545.12 / $545.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.17 / $521.72 / $580.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.50 / $1,424.47 / $1,846.53
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.85 / $760.84 / $1,304.30
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 / $702.03 / $5,184.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.82 / $526.41 / $877.36