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Montana rates for HCPCS L1990

Ankle-foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated

Facilitymedian $490 · 10th–90th $331–$6170%20%10th90th$490Professionalmedian $380 · 10th–90th $229–$6170%10%10th90th$380$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
$229.09 / $295.12 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $524.81 / $524.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $489.78 / $954.99
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $489.78 / $954.99
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $512.86 / $676.08
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $398.11 / $602.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $316.23 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $251.19 / $380.19