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Idaho 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
$273.57 / $610.66 / $645.64
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 / $857.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.36 / $558.05 / $623.34
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.25 / $530.16 / $568.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $610.51 / $737.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.99 / $551.99 / $827.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.99 / $415.04 / $596.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $459.39 / $761.96