go back

Arizona 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
$422.06 / $580.03 / $951.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.64 / $949.64 / $949.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.02 / $1,000.72 / $1,809.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.54 / $923.39 / $1,211.95
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 / $512.48 / $1,253.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.04 / $735.35 / $5,034.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.03 / $481.81 / $737.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.03 / $481.81 / $725.77