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Connecticut 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
Facility
Modifier
Low / Median / High Price
$512.85 / $512.85 / $512.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.19 / $512.85 / $580.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$817.75 / $1,055.16 / $1,207.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.00 / $445.00 / $616.29
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 / $702.03
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$685.85 / $685.85 / $685.85
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.85 / $685.85 / $970.75
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.17 / $612.17 / $612.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.82 / $526.41 / $877.36