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Utah 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
$423.22 / $423.22 / $423.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.57 / $615.59 / $3,044.44
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $391.57 / $543.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.62 / $578.62 / $694.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.19 / $417.19 / $949.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.76 / $481.81 / $500.17