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Indiana rates for HCPCS L1843

Knee Orthosis Single Upright Thigh And Calf With Adjustable Flexion And Extension Joint (Uni- Centric 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.08 / $535.08 / $1,081.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.50 / $555.66 / $580.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$854.06 / $967.58 / $1,081.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.24 / $584.04 / $805.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.19 / $1,189.20 / $1,621.64
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.93 / $1,189.20 / $1,459.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $1,081.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $1,108.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $516.82 / $725.93