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Montana rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.23 / $12.92 / $14.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.03 / $21.45 / $28.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.03 / $28.65 / $30.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $21.03 / $28.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.02 / $21.57 / $28.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.41 / $8.66 / $12.80