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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$320.37 / $555.66 / $625.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,491.86 / $2,014.94 / $2,385.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.19 / $689.19 / $954.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.23 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $702.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.53 / $526.41 / $877.36