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Montana rates for HCPCS L3221

Orthopedic footwear, mens shoe, depth inlay, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.49 / $92.29 / $92.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.84 / $69.84 / $139.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.84 / $71.95 / $136.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.24 / $85.05 / $139.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.84 / $126.18 / $163.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.20 / $56.30 / $68.72