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Maine rates for HCPCS L1844

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, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,071.52 / $2,951.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,290.87 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,174.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,995.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $891.25 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $1,905.46