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Rhode Island 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
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