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Vermont rates for HCPCS L1843

Knee Orthosis Single Upright Thigh And Calf With Adjustable Flexion And Extension Joint (Uni- Centric 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.37 / $514.91 / $594.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.67 / $853.67 / $853.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $775.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $601.54 / $748.40
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $775.53
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $702.03 / $748.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.94 / $625.04 / $1,219.82