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Montana rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.27 / $39.27 / $195.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.85 / $63.85 / $63.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $68.65 / $68.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $55.83 / $68.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.45 / $65.38 / $68.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $51.53 / $68.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.48 / $32.61 / $49.91