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Virginia 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
$305.47 / $541.40 / $541.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.47 / $541.40 / $586.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.08 / $682.08 / $724.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.37 / $653.37 / $816.77
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.09 / $567.09 / $567.09
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 / $472.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.34 / $617.78 / $977.37
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.36 / $610.71 / $990.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.21 / $904.06 / $1,325.12
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.78 / $872.44 / $1,108.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.78 / $872.44 / $1,108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $546.27 / $872.44