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Montana rates for HCPCS L1843

Knee Orthosis Single Upright Thigh And Calf With Adjustable Flexion And Extension Joint (Uni- Centric 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.77 / $580.03 / $3,044.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.33 / $1,067.33 / $1,067.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $1,147.60 / $1,147.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.03 / $933.23 / $1,147.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$538.42 / $1,092.96 / $1,147.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.03 / $861.33 / $1,148.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.46 / $481.81 / $737.30