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Montana rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.03 / $30.74 / $146.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.42 / $51.42 / $51.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $55.28 / $55.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.89 / $55.28 / $55.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.94 / $52.65 / $55.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.89 / $41.50 / $55.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.98 / $23.21 / $26.57