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Montana rates for HCPCS L3201

Orthopedic Shoe Oxford With Supinator Or Pronator Infant (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.51 / $16.51 / $16.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $30.06 / $56.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $30.96 / $55.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $34.63 / $56.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $51.44 / $66.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.65 / $22.95 / $27.83