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Missouri 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
$367.02 / $367.02 / $660.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.02 / $380.36 / $586.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.09 / $601.09 / $694.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$615.51 / $646.29 / $2,841.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $653.37 / $803.04
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 / $472.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.36 / $570.54 / $3,006.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.83 / $459.39 / $1,119.26
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.16 / $799.16 / $799.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.85 / $459.39 / $807.06