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Montana rates for HCPCS L3201

Orthopedic shoe, Oxford with supinator or pronator, infant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $25.70 / $33.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $30.20 / $56.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $61.66 / $61.66
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $61.66 / $61.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $33.88 / $64.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $57.54 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $27.54 / $28.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $22.91 / $27.54