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Montana rates for HCPCS L3209

Surgical Boot Each Child (Special Coverage Instructions Apply. See Mcm: 2079)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.46 / $12.46 / $12.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.60 / $27.60 / $42.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $28.43 / $42.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.16 / $27.60 / $42.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $38.82 / $50.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.27 / $17.32 / $25.59