go back

Maine 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
Professional
Modifier
Low / Median / High Price
$504.39 / $603.47 / $640.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.46 / $1,215.85 / $2,253.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.00 / $616.29 / $616.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $775.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $702.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.33 / $854.33 / $854.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.03 / $640.47 / $640.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.94 / $526.41 / $1,210.58