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Maine rates for HCPCS L1850

Knee Orthosis Swedish Type Prefabricated Off- The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.26 / $242.08 / $242.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.93 / $273.27 / $506.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.68 / $206.93 / $206.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.95 / $214.95 / $293.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.91 / $156.91 / $214.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.92 / $322.92 / $322.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.57 / $242.08 / $242.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.65 / $198.97 / $552.23