go back

Montana rates for HCPCS L1843

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 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
$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