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Montana rates for HCPCS L1720

Legg Perthes Orthosis Trilateral (Tachdijan Type) Custom- Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.94 / $5,710.93 / $5,710.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.77 / $1,558.75 / $1,558.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.77 / $1,267.58 / $1,558.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$827.66 / $1,484.52 / $1,558.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.77 / $1,169.91 / $1,610.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.38 / $740.61 / $919.70