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Massachusetts rates for HCPCS L1847

Knee orthosis (KO), double upright with adjustable joint, with inflatable air support chamber(s), 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
$295.52 / $295.52 / $295.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.52 / $325.75 / $433.20
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.91 / $1,749.00 / $3,239.07
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.43 / $502.46 / $660.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.90 / $457.40 / $457.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.84 / $386.84 / $497.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.39 / $386.83 / $803.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.65 / $547.65 / $575.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.79 / $3,239.07 / $3,239.07
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.38 / $337.45 / $660.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.22 / $337.45 / $676.39