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Oregon 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
$436.52 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $588.84 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $1,202.26 / $1,479.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $724.44 / $741.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $602.56 / $776.25
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $812.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $575.44 / $1,047.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $537.03 / $794.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,348.96 / $2,290.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $630.96 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,122.02 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $457.09 / $741.31