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Montana rates for HCPCS L4100

Replace Leather Cuff Kafo, Proximal Thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.74 / $452.07 / $452.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.43 / $123.39 / $123.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.43 / $100.34 / $123.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.51 / $117.51 / $123.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.43 / $92.61 / $135.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.99 / $58.63 / $67.11