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Montana rates for HCPCS L1940

Ankle-foot orthosis (AFO), plastic or other material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $371.54 / $537.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $588.84 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $478.63 / $588.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $549.54 / $1,071.52
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $549.54 / $1,071.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $512.86 / $758.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $436.52 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $346.74 / $363.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $275.42 / $316.23