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Montana rates for HCPCS L4205

Repair of orthotic device, labor component, per 15 minutes

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $16.98 / $22.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $30.90 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $23.44 / $30.90
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $48.98 / $50.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $48.98 / $50.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $30.20 / $42.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $39.81 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $14.13 / $17.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $14.13 / $19.50