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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
$21.66 / $21.66 / $40.85
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
$35.20 / $35.20 / $35.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $37.85 / $37.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.09 / $37.85 / $37.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.10 / $36.04 / $37.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.41 / $29.97 / $41.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.25 / $17.98 / $23.45