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Montana rates for HCPCS L1904

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, custom fabricated

Facilitymedian $513 · 10th–90th $347–$6460%20%40%10th90th$513Professionalmedian $347 · 10th–90th $240–$5620%10%20%10th90th$347$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $562.34 / $562.34
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $512.86 / $1,000.00
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $512.86 / $1,000.00
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $489.78 / $724.44
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $416.87 / $562.34
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $263.03 / $407.38