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Maine 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
Professional
Modifier
Low / Median / High Price
$467.74 / $562.34 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,174.90 / $1,318.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $630.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,023.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $588.84 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $457.09 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $562.34 / $977.24