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Montana rates for HCPCS L4090

Replace Metal Bands Kafo-Afo, Calf Or Distal Thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.86 / $357.76 / $357.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $106.83 / $106.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.72 / $86.87 / $106.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.72 / $101.74 / $106.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.72 / $80.17 / $117.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.88 / $50.75 / $77.67