go back

Montana rates for HCPCS L1852

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, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.95 / $586.95 / $645.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.47 / $795.47 / $795.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.80 / $857.38 / $857.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.80 / $857.38 / $857.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.84 / $647.80 / $857.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.96 / $647.80 / $857.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.21 / $459.39 / $733.69