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Montana rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $213.80 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $281.84 / $346.74
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $323.59 / $630.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $323.59 / $630.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $309.03 / $457.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $263.03 / $346.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $190.55 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $151.36 / $194.98