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Louisiana 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
$570.30 / $605.41 / $815.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.11 / $586.95 / $658.05
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.27 / $681.27 / $681.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.46 / $1,569.05 / $2,205.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.13 / $647.98 / $647.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.14 / $446.14 / $446.14
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 / $713.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.26 / $504.46 / $840.77