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Tennessee 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
$510.48 / $510.48 / $557.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.71 / $510.48 / $955.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.04 / $1,021.19 / $1,021.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.22 / $632.51 / $632.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $632.51
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.38 / $538.66 / $692.00