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Montana rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.46 / $991.87 / $991.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.66 / $323.66 / $323.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $348.00 / $348.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.91 / $283.00 / $348.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.45 / $331.43 / $348.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.91 / $261.19 / $348.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.04 / $151.62 / $194.71