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Utah 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
$296.57 / $296.57 / $296.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.57 / $471.23 / $2,656.81
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 / $632.51 / $741.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.45 / $694.28 / $902.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.76 / $928.75 / $928.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.86 / $665.73 / $998.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.70 / $459.39 / $552.50