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Indiana rates for HCPCS L1840

Knee Orthosis Derotation Medial-Lateral Anterior Cruciate Ligament Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.79 / $560.79 / $1,133.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.47 / $576.04 / $608.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.12 / $1,014.09 / $1,133.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.74 / $656.91 / $906.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.80 / $1,246.36 / $1,694.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.10 / $1,246.36 / $1,529.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $732.96 / $1,133.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $535.05 / $1,162.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,657.40 / $1,657.40 / $1,657.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.53 / $540.07 / $777.69