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Tennessee 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
$403.38 / $403.38 / $440.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.12 / $425.79 / $707.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.52 / $810.86 / $866.03
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 / $464.99 / $636.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,110.64 / $3,153.85 / $3,153.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,494.50 / $4,494.50 / $4,856.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $521.96 / $769.49