go back

Vermont 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
$438.73 / $546.47 / $630.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.97 / $641.97 / $641.97
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 / $1,030.10
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $712.60
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $679.05 / $1,030.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.98 / $840.73 / $1,293.30