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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
$502.50 / $502.50 / $691.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.66 / $447.09 / $759.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.29 / $647.80 / $881.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.63 / $881.60 / $910.95
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.61 / $961.93 / $1,350.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.42 / $1,041.89 / $3,006.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $550.27 / $1,258.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.60 / $917.11 / $1,206.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.60 / $1,053.97 / $1,865.34
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.85 / $669.21 / $1,128.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $474.70 / $1,099.38
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.42 / $785.42 / $785.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.48 / $785.42 / $785.42