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Wyoming rates for HCPCS L1852

Knee orthosis (KO), double 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
$318.39 / $318.39 / $622.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.99 / $551.99 / $551.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.99 / $551.99 / $551.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.80 / $647.80 / $881.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $550.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $459.39 / $513.58