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Wisconsin rates for HCPCS L1851

Knee Orthosis (Ko) Single Upright Thigh And Calfwith 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
$389.12 / $389.12 / $389.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.12 / $604.08 / $877.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.99 / $720.49 / $1,192.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.14 / $654.99 / $805.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$777.73 / $1,401.68 / $1,401.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $2,154.77 / $2,677.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $950.12 / $1,232.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.12 / $583.67 / $785.99
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.98 / $654.99 / $785.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.96 / $700.42 / $3,153.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.17 / $577.12 / $984.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $611.30
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.12 / $583.67 / $785.99
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.98 / $654.99 / $785.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.99 / $1,335.18 / $1,740.42
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $1,271.82 / $3,153.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $636.97 / $4,494.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.03 / $898.03 / $898.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.03 / $898.03 / $898.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.75 / $562.11 / $902.54