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Montana rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $54.02 / $236.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.83 / $87.83 / $87.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $94.43 / $94.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.00 / $76.80 / $94.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.14 / $89.93 / $94.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.00 / $70.88 / $103.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.54 / $44.87 / $68.66