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Maryland rates for HCPCS L1845

Knee orthosis (KO), double 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
$596.34 / $596.34 / $596.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.15 / $498.58 / $855.97
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.00 / $587.00 / $748.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $632.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $632.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.49 / $1,094.98 / $1,576.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.35 / $546.27 / $870.75
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $551.74 / $766.49