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Oklahoma 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
$344.17 / $344.17 / $344.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.42 / $344.17 / $586.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.92 / $694.92 / $694.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.35 / $637.35 / $637.35
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.17 / $406.36 / $3,006.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.26 / $504.46 / $924.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.26 / $504.46 / $733.69