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Minnesota 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
$751.17 / $751.17 / $751.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.03 / $580.03 / $751.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.10 / $1,081.08 / $1,505.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.87 / $1,027.04 / $1,081.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $3,335.39 / $9,263.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.25 / $1,328.45 / $1,591.63
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,980.18 / $3,200.14 / $7,294.30
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.25 / $1,253.25 / $1,289.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.37 / $1,081.08 / $5,034.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.56 / $539.34 / $1,124.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $534.90 / $1,898.93