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Arkansas 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
Facility
Modifier
Low / Median / High Price
$604.08 / $604.08 / $604.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.34 / $604.08 / $604.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.25 / $1,241.80 / $1,379.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.16 / $1,055.16 / $1,086.92
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.16 / $1,055.16 / $1,055.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $869.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $849.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $489.56 / $653.41