go back

Massachusetts 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
$461.03 / $461.03 / $461.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.21 / $508.17 / $675.81
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$823.54 / $2,728.39 / $5,034.28
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.48 / $783.83 / $1,030.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,152.13 / $1,362.55 / $1,754.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.93 / $761.12 / $761.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.23 / $702.03 / $739.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $1,253.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.33 / $854.33 / $897.05
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.17 / $612.17 / $612.17
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,194.61 / $5,034.28 / $5,034.28
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.23 / $526.41 / $1,030.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.35 / $564.02 / $1,030.43