go back

Washington, DC 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
$431.86 / $431.86 / $431.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.86 / $431.86 / $580.03
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.37 / $634.37 / $721.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $512.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.85 / $685.85 / $2,094.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.94 / $526.41 / $790.94