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Vermont 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
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $707.95
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $478.63 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $741.31 / $2,187.76