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Wyoming 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
$532.58 / $532.58 / $832.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$928.75 / $928.75 / $928.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.75 / $928.75 / $928.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $1,012.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $632.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.20 / $459.39 / $510.01