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Montana rates for HCPCS L1990

Ankle Foot Orthosis Double Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Double Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.83 / $1,931.85 / $1,931.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.41 / $490.41 / $490.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $527.29 / $527.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.79 / $428.79 / $527.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.98 / $502.18 / $527.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.79 / $395.75 / $577.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.43 / $250.53 / $383.38