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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
$872.53 / $1,167.90 / $1,167.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.31 / $2,217.16 / $4,109.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,095.47 / $1,143.14 / $1,143.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,186.93 / $1,186.93 / $1,414.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.46 / $866.46 / $1,186.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,557.87 / $1,557.87 / $1,557.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,083.40 / $1,167.90 / $1,167.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,193.78 / $1,193.78 / $1,193.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.57 / $1,101.71 / $2,664.24