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Hawaii 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 / $580.03 / $603.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$838.24 / $838.24 / $838.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.03 / $702.03 / $1,160.68
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.16 / $1,104.88 / $1,104.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.61 / $1,055.16 / $1,477.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.39 / $838.24 / $1,316.04
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.46 / $849.98 / $1,004.32