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Montana rates for HCPCS L4030

Replace Quadrilateral Socket Brim, Custom Fitted

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.83 / $2,188.15 / $2,188.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $597.24 / $597.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.46 / $597.24 / $597.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.12 / $568.79 / $597.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.25 / $477.88 / $666.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.48 / $283.76 / $434.24