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Louisiana 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
Facility
Modifier
Low / Median / High Price
$587.39 / $623.54 / $839.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.95 / $615.59 / $677.76
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.90 / $900.90 / $900.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.97 / $1,616.05 / $2,271.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.96 / $679.23 / $679.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.65 / $558.65 / $558.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $712.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $636.97 / $712.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.20 / $519.57 / $769.49