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Texas 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
$471.23 / $489.71 / $783.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.64 / $489.71 / $762.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.61 / $749.21 / $844.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.19 / $502.19 / $628.30
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.65 / $844.18 / $1,055.22
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.47 / $143.47 / $1,055.22
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 / $632.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,772.90 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.57 / $731.84 / $1,055.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.57 / $949.70 / $1,055.22
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.69 / $1,107.98 / $1,846.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.57 / $705.06 / $1,055.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $741.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.83 / $553.60 / $659.05
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.74 / $557.09 / $1,055.22