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Virginia 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
$541.40 / $541.40 / $805.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.15 / $541.40 / $576.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,094.98 / $1,094.98 / $1,162.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.09 / $557.09 / $696.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.00 / $587.00 / $748.52
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.49 / $985.48 / $1,313.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.57 / $673.42 / $1,228.57
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.00 / $1,314.00 / $1,823.89
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.90 / $826.37 / $1,306.83
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.90 / $826.37 / $1,306.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.12 / $546.27 / $822.87