go back

Pennsylvania 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
$450.64 / $3,055.87 / $3,128.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.00 / $498.58 / $696.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.73 / $930.73 / $930.73
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.78 / $1,094.98 / $1,094.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $1,157.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $1,013.41
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.76 / $1,157.34 / $2,198.96
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.52 / $674.52 / $5,060.78
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.49 / $875.99 / $930.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.98 / $3,055.87 / $3,128.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.15 / $517.75 / $875.98
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.40 / $1,435.00 / $1,874.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $1,157.34
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $1,170.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.18 / $1,042.22 / $1,042.22
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.18 / $1,042.22 / $1,101.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.03 / $546.27 / $910.45