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Arizona rates for HCPCS L1851

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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.99 / $615.59 / $758.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.80 / $663.80 / $675.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.58 / $554.79 / $1,003.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.95 / $511.93 / $671.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $636.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $464.99 / $748.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.39 / $425.96 / $3,153.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.22 / $481.81 / $769.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.66 / $481.81 / $769.49