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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
$941.14 / $6,891.32 / $6,891.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,974.80 / $1,974.80 / $1,974.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,186.93 / $2,123.31 / $2,123.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.93 / $1,726.70 / $2,123.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$998.72 / $2,022.20 / $2,123.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.93 / $1,593.64 / $2,256.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.73 / $893.69 / $1,023.02