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Iowa 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
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $478.63 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $645.65 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $933.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $977.24 / $1,348.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $1,047.13 / $3,019.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $616.60 / $1,548.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $954.99 / $1,995.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,884.03
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $630.96 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $812.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $794.33 / $794.33