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Utah 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
$576.95 / $576.95 / $576.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.95 / $839.61 / $6,891.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,186.93 / $1,186.93 / $1,186.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.46 / $1,186.93 / $1,265.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.28 / $1,476.26 / $1,919.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,770.71 / $1,974.80 / $1,974.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.53 / $1,415.54 / $2,123.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,193.78 / $1,193.78 / $1,193.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.75 / $893.69 / $1,516.65