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Montana rates for HCPCS L1846

Knee orthosis (KO), double 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
$755.88 / $755.88 / $4,841.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,234.82 / $1,234.82 / $1,234.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.60 / $1,327.68 / $1,327.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.60 / $1,079.67 / $1,327.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$666.85 / $1,264.46 / $1,327.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.60 / $996.48 / $1,370.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.49 / $627.88 / $718.74