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North Carolina 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
$951.75 / $951.75 / $1,641.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.86 / $951.75 / $951.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$990.18 / $1,612.30 / $1,985.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.71 / $815.19 / $869.54
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 / $1,253.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.04 / $951.75 / $1,237.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.00 / $612.00 / $738.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.83 / $1,385.83 / $1,860.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.78 / $537.41 / $765.63
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.32 / $5,034.28 / $5,034.28
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,442.94 / $5,442.94 / $7,913.70