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Montana rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $23.99 / $34.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $35.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $38.02 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $31.62 / $38.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $35.48 / $69.18
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $35.48 / $69.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $35.48 / $53.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $38.02 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $20.42 / $22.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $17.78 / $23.44