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Montana rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $131.83 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $199.53 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $162.18 / $199.53
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $186.21 / $363.08
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $186.21 / $363.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $177.83 / $229.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $151.36 / $199.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $120.23 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $95.50 / $109.65