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Hawaii 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
$586.95 / $586.95 / $610.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.80 / $647.80 / $647.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.80 / $928.79 / $928.79
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.35 / $884.14 / $884.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.04 / $844.35 / $1,182.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.54 / $835.91 / $928.79
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.75 / $802.05 / $810.87