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Alaska rates for HCPCS L1843

Knee orthosis (KO), single 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
Professional
Modifier
Low / Median / High Price
$580.03 / $903.89 / $949.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $748.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.04 / $311.04 / $311.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.40 / $1,002.40 / $1,582.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.04 / $311.04 / $702.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $748.40 / $1,040.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.99 / $1,008.96 / $1,316.04