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Utah rates for HCPCS L1852

Knee Orthosis (Ko) Double Upright Thigh And Calfwith 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
$403.53 / $403.53 / $403.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.05 / $586.95 / $2,656.81
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $373.55 / $518.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.99 / $551.99 / $640.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.99 / $397.99 / $857.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.16 / $459.39 / $733.69