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Montana rates for HCPCS L3999

Upper Limb Orthotic, Not Otherwise Specified

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $14.40 / $14.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $1,800,000.00 / $2,400,000.00