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Arizona 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
$223.22 / $586.95 / $739.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.88 / $505.35 / $913.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.72 / $466.30 / $612.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.80 / $647.80 / $647.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $713.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.54 / $406.36 / $3,006.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.36 / $459.39 / $733.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.11 / $459.39 / $733.69