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Oklahoma 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
$513.90 / $513.90 / $757.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.87 / $513.89 / $580.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$951.67 / $951.67 / $951.67
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 / $702.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.04 / $661.82 / $5,034.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $518.03 / $1,074.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $481.81 / $691.21