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West 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
$565.69 / $565.69 / $565.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.87 / $541.40 / $575.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$737.52 / $1,478.22 / $1,916.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.74 / $794.26 / $1,361.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $1,329.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $632.51 / $4,946.33
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.99 / $875.99 / $875.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.03 / $546.27 / $910.45