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Pennsylvania 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
$40.49 / $324.08 / $358.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.08 / $418.55 / $610.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.30 / $617.78 / $617.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.78 / $647.80 / $647.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $713.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.36 / $617.78 / $1,173.78
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.45 / $586.89 / $739.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.49 / $324.08 / $1,254.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.08 / $409.59 / $645.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.10 / $553.29 / $1,582.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.78 / $647.80 / $647.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $720.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.39 / $710.39 / $959.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.15 / $710.39 / $959.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.67 / $550.27 / $916.06