go back

Massachusetts 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
$429.96 / $429.96 / $429.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.73 / $440.42 / $767.39
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.54 / $1,594.47 / $3,006.95
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.85 / $625.40 / $763.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.51 / $1,266.97 / $1,631.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.74 / $952.11 / $1,318.16
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.08 / $800.08 / $840.08
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.24 / $478.24 / $625.40
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,268.45 / $3,006.95 / $3,006.95
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.85 / $498.37 / $781.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.85 / $508.97 / $800.08