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Minnesota rates for HCPCS L1833

Knee orthosis (KO), adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $407.38 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $426.58 / $812.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $691.83 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $691.83 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,819.70 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $645.65 / $724.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $3,388.44
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $776.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $489.78 / $1,071.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $380.19 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $338.84 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $380.19 / $776.25