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Maryland rates for HCPCS L1847

Knee Orthosis Double Upright With Adjustable Joint With Inflatable Air Support Chamber(S) Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.83 / $295.52 / $528.75
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.60 / $377.60 / $462.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.84 / $386.84 / $386.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.39 / $282.39 / $386.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.47 / $676.39 / $974.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.14 / $337.45 / $537.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.89 / $370.89 / $473.47