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Maine rates for HCPCS L1840

Knee orthosis (KO), derotation, medial-lateral, anterior cruciate ligament, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.14 / $667.02 / $667.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.39 / $1,266.30 / $2,347.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.91 / $661.04 / $661.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $732.96 / $807.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $535.05 / $732.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.74 / $889.74 / $889.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.76 / $667.02 / $667.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.18 / $548.24 / $1,521.63