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Vermont 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
Professional
Modifier
Low / Median / High Price
$418.55 / $508.14 / $586.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.28 / $607.28 / $607.28
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 / $982.06
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.29 / $647.80 / $647.80
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $982.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.32 / $781.75 / $815.81