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Montana rates for HCPCS L1700

Legg Perthes orthosis, (Toronto type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.88 / $6,618.47 / $6,618.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.63 / $1,806.45 / $1,806.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.63 / $1,469.02 / $1,806.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$959.18 / $1,720.43 / $1,806.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.63 / $1,355.82 / $1,807.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.75 / $858.30 / $1,313.43