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Louisiana 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
$570.30 / $605.41 / $815.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.34 / $605.41 / $691.92
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.86 / $780.86 / $780.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.46 / $1,569.05 / $2,205.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.36 / $749.21 / $749.21
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.47 / $143.47 / $143.47
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 / $627.19 / $632.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.26 / $486.73 / $707.90