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New Jersey 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
$359.21 / $359.21 / $359.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.21 / $459.19 / $580.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $1,055.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $923.94
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.98 / $970.75 / $1,382.26
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.43 / $1,055.16 / $1,055.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.48 / $532.15 / $968.70