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Montana rates for HCPCS L1844

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, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,288.25 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,737.80 / $2,137.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,995.26 / $3,890.45
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,995.26 / $3,890.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,905.46 / $2,454.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,584.89 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,122.02 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $891.25 / $1,023.29