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Wyoming 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
$333.75 / $333.75 / $673.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.62 / $578.62 / $578.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.62 / $578.62 / $578.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $984.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $464.99 / $636.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.69 / $481.81 / $538.64