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Vermont rates for HCPCS L1845

Knee orthosis (KO), double 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
$305.45 / $478.80 / $552.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.79 / $793.79 / $793.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $721.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $632.51 / $741.71
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $721.15
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $632.51 / $741.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.32 / $582.87 / $1,134.27