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Montana rates for HCPCS L2126

Knee-ankle-foot orthosis (KAFO), fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.15 / $4,453.05 / $4,453.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.96 / $1,590.70 / $1,590.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.96 / $1,293.56 / $1,590.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.12 / $1,514.95 / $1,590.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.96 / $1,193.89 / $1,591.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.29 / $673.03 / $1,029.90