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Maryland rates for HCPCS L1843

Knee orthosis (KO), single 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 item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.11 / $248.11 / $248.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.86 / $516.16 / $824.85
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.37 / $634.37 / $721.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $702.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.61 / $1,055.16 / $1,519.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.46 / $526.41 / $839.10
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.50 / $578.59 / $738.61