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Montana rates for HCPCS L3455

Heel New Leather Standard (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.86 / $138.13 / $138.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.38 / $52.01 / $52.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.38 / $52.01 / $52.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.43 / $49.53 / $52.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.03 / $39.90 / $52.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.76 / $21.86 / $36.43