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Mississippi 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
$609.12 / $609.12 / $970.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.06 / $623.54 / $970.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.28 / $842.28 / $842.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.28 / $842.28 / $842.28
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 / $512.48 / $702.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $516.01 / $809.44