go back

Tennessee 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
$395.81 / $395.81 / $432.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.02 / $417.80 / $645.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.92 / $886.70 / $1,226.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.05 / $817.52 / $904.06
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 / $545.66
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,059.54 / $3,006.95 / $3,006.95
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,196.00 / $4,196.00 / $4,633.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.85 / $542.44 / $733.69