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Arizona rates for HCPCS L1845

Knee orthosis (KO), double 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
$151.05 / $581.37 / $581.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.33 / $553.04 / $993.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.75 / $828.75 / $828.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.75 / $873.33 / $1,578.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.75 / $805.84 / $1,057.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $632.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $1,170.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.57 / $641.72 / $4,802.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.79 / $459.39 / $702.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.79 / $459.39 / $692.00