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North Dakota 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
$795.17 / $795.17 / $795.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.03 / $580.03 / $795.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.92 / $1,208.27 / $1,238.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.25 / $1,265.78 / $1,591.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.39 / $795.17 / $5,034.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.42 / $534.90 / $870.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $534.90 / $870.83