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Montana rates for HCPCS L3670

Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $40.14 / $462.21
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
$121.74 / $121.74 / $121.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $130.88 / $130.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.64 / $106.45 / $130.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.50 / $124.66 / $130.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.64 / $98.24 / $130.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.21 / $62.19 / $98.64