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Montana rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $10.00 / $14.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $28.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $23.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $23.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $15.85 / $28.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $26.92 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $10.72 / $35.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.71 / $10.72