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Maine rates for HCPCS L1851

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, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.40 / $640.47 / $640.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$615.82 / $797.85 / $1,478.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.32 / $685.32 / $685.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $636.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $464.99 / $636.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.45 / $860.45 / $860.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.59 / $640.47 / $640.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.94 / $538.64 / $1,219.06