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Wisconsin 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
$368.43 / $368.43 / $368.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.43 / $502.50 / $767.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.85 / $687.34 / $1,137.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.11 / $624.85 / $781.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$726.08 / $1,337.18 / $1,337.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.80 / $2,011.24 / $2,554.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $1,034.60 / $1,175.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.43 / $552.65 / $749.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.05 / $624.85 / $749.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.36 / $663.17 / $3,006.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.39 / $558.05 / $884.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $528.08
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.43 / $552.65 / $749.82
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.05 / $624.85 / $749.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.85 / $1,268.52 / $1,661.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.80 / $1,213.30 / $3,006.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $647.80 / $4,196.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.68 / $845.68 / $845.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.68 / $845.68 / $845.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.83 / $507.41 / $853.21