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Montana rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.61 / $1,769.11 / $1,769.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $504.05 / $504.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.55 / $409.90 / $504.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.39 / $480.05 / $504.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.55 / $378.32 / $536.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.36 / $229.42 / $351.08