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Montana rates for HCPCS L1650

Hip orthosis (HO), abduction control of hip joints, static, adjustable, (Ilfled type), prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $177.83 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $309.03 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $251.19 / $309.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $288.40 / $562.34
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $288.40 / $562.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $275.42 / $354.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $229.09 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $147.91 / $162.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $128.82 / $147.91