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California 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
$553.04 / $553.04 / $2,656.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.56 / $553.04 / $1,043.16
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.73 / $736.66 / $736.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.02 / $1,411.63 / $2,922.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.35 / $557.09 / $943.44
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.20 / $1,090.17 / $1,946.73
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,221.79 / $2,845.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.40 / $632.51 / $632.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $741.71
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.56 / $419.47 / $1,012.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.50 / $644.58 / $1,399.66
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,695.61 / $4,802.66 / $4,802.66
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,555.28 / $5,555.28 / $8,680.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,163.20 / $2,163.20 / $2,163.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.57 / $799.85 / $966.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $632.51 / $910.22
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,738.02 / $1,738.02 / $1,738.02
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.56 / $594.25 / $736.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.12 / $459.39 / $929.04