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Indiana rates for HCPCS L1844

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, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $933.25 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,862.09 / $2,344.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,096.48 / $1,905.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $2,344.23 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,348.96 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,318.26