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Montana rates for HCPCS L4392

Replacement, soft interface material, static AFO

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $78.48 / $78.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.51 / $27.51 / $27.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.80 / $29.58 / $29.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.80 / $24.04 / $29.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.10 / $28.17 / $29.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.80 / $22.19 / $29.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.40 / $12.61 / $21.02