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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
$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