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Montana rates for HCPCS L1840

Knee Orthosis Derotation Medial-Lateral Anterior Cruciate Ligament Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.23 / $3,985.02 / $3,985.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $1,087.67 / $1,087.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.96 / $1,087.67 / $1,087.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$577.52 / $1,035.88 / $1,087.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.35 / $834.44 / $1,191.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.08 / $516.79 / $635.00