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Montana rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.81 / $3,732.96 / $3,732.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.98 / $1,018.88 / $1,018.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.23 / $1,018.88 / $1,018.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.00 / $970.36 / $1,018.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.71 / $781.66 / $1,115.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$605.13 / $633.41 / $633.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.54 / $484.10 / $740.81