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Alaska 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
$436.52 / $588.84 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $691.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $794.33 / $794.33
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,737.80
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $794.33 / $831.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $794.33 / $870.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $645.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $630.96 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $776.25 / $2,344.23