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Maryland rates for HCPCS L1843

Knee Orthosis Single Upright Thigh And Calf With Adjustable Flexion And Extension Joint (Uni- Centric 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 (Revised 01/01/14)

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