go back

Indiana 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
$361.48 / $361.48 / $624.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.66 / $375.38 / $586.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.12 / $634.26 / $634.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.63 / $559.24 / $624.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.44 / $653.37 / $880.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.56 / $687.34 / $937.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.12 / $687.34 / $843.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.29 / $647.80 / $647.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $862.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.26 / $482.50 / $733.69