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Montana rates for HCPCS L1640

Hip orthosis (HO), abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $363.08 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $549.54 / $676.08
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,202.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $524.81 / $741.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $501.19 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $323.59 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $257.04 / $302.00